Description: Blockchain technology has the potential to significantly improve the quality of life and overall health of the members of a health system, while also adding to administrative efficiencies. For the first time, we will have access to members’ entire diagnoses and prescription history, consumer behavioral attributes, and other socio-economic determinants which that are valuable inputs to designing appropriate benefits and proper care management plans. Through the blockchain, we will be able to access data not just of the existing members of the health system but also of potential enrollees and new entrants. The data can be accessed by querying the blockchain through a permissioned granted by the member. This information can be very useful in performing feasibility studies for evaluating entry into newer markets and/or newer products, developing customized care plans, and designing efficient value-based contracts. By executing smart contracts on the blockchain, we will be able to achieve administrative efficiencies like never before. The applications of blockchain technology are numerous and ground-breaking. Organizations that do not pay heed to the benefits that blockchain can bring may find themselves left behind as the rest of the industry marches forward in its quest for efficiency and member satisfaction.

Description: As providers are considering accountable and value based care models, it is critical to strategically think through how to achieve a sustainable business model into the future. This requires actuarial and clinical/provider capabilities to assess the care management and financial levers to help a client through the transition.

Description: Volunteers and staff from the SOA are working with the Centers for Disease Control on public health initiatives to improve population health.

Description: This article provides a detailed description of the unbalanced subsidy provisions in the Affordable Care Act with easy to follow numerical illustrations. An understanding of the illustrative calculations is necessary to understand the subsidy implications. The article highlights some surprising and likely unintended results that will be interest to issuers, employers, consumers, regulators and policymakers. Actuaries can add expertise to their clients and to the public discussion with a proper understanding of the subsidy calculations and the resulting implications.

Description: This article provides an overview of the financial results of managed care plans over time using a collection of the NAIC financial statements.

Description: Two years ago, before COVID-19 changed everything about how we provide and receive health care, telehealth was largely provided by third-party vendors to treat a narrow range of acute one-and-done conditions. The value proposition was simple: a fast and easy member experience would drive satisfaction and engagement; high member satisfaction and engagement would drive health plan savings and member retention. Clearly, from the perspective of utilization, telehealth—as a viable alternative to in-person care during a pandemic—worked. And with COVID-19’s nudge—or was that a push?—toward cultural acceptance, the health care system is in a better position to capitalize on telehealth’s original promise of expanded access, lower cost and better outcomes than it was two years ago. But in the wake of the pandemic, it is just as clear to us that if telehealth is to live up to its full potential, some changes are needed. The rest of this article presents five ideas for improving the delivery of telehealth going forward.

Description: Results of a survey of healthcare organizations regarding use and plans for Predictive Analytics

Description: This article is intended to inform readers about the current state of mental health and health care in the US, as were it's heading moving forward.

Description: Recap of National Academy of Social Insurance NASI annual conference “Getting to Universal Health Insurance Coverage”

Description: This article summarizes a joint SOA/Kaiser Family Foundation initiative focused on addressing the rising cost of health care in the United States.