Description: As actuaries in health care, we spend most of our time focused on reviewing claims, enrollment and clinical data. That information is captured while patients are in health care facilities. Yet most people spend only a small fraction of their time in these facilities. This article explores what types of data are available to actuaries the provide a more holistic view of the member so that a members physical and emotional needs, the social determinants of health can be taken into consideration along with their clinical needs. Two uses cases are presented so actuaries can see how these types of analyses can be leveraged to improve clinical, operational, and financial performance of risk bearing health entities. Understanding the customer (member) not just the patient enables actuaries to provide new insights and values to our stakeholders across a wide range of business and risk applications.

Description: Social Insurance & Public Finance Section council members provide a recap of sessions from the 2021 SOA Health Meeting, with a focus on sessions covering Medicare, Medicaid, the ACA, and public policy. The authors include a description of SIPF Section-sponsored sections, including a session on the ACA and a session on CMS's Direct Contracting Model.

Description: Presented at April 1985 Spring Meeting. This session discussed: Definition of good and sufficient provision for unpaid and actuarial liabilities as used in the NAIC model bill, Actuary and auditor relationships in documentation, reasonableness of results, materiality, margins, and disclosure, Techniques for estimating unpaid claim liabilities, Reverse testing, Considerations regarding incurred date coding in establishing claim reserves, Reserving methodologies for alternative funding products, Reserves for catastrophic claims, Measurement, evaluation, and adjustment for claim department backlogs, changes in claim submission patterns, and environmental changes, etc.

Description: Presentation at October 1985 Annual Meeting. This session will discuss trends in medical technology as they affect health care benefits programs, including: life extension, organ transplants, high-cost procedures, and plan design.

Description: Presented at April 1986 Spring Meeting. This session discussion is about the effect of recent changes in tax structures on employee benefits - their value to employees, limitations on deductibility by employers, taxability to employees, and the direction of likely future changes. Will the continued emphasis on additional revenue generation result in a shift in employer emphasis toward additional cash compensation versus employee benefits?

Description: Presented at April 1986 Spring Meeting. This session discussion is about the impact of wellness programs on medical plan experience/non-medical plan experience, health status as a pricing variable, likely future developments.

Description: Numerous behavioral finance theories have emerged in recent years, many of which apply to insurance. The presenters look at key theories and their use in explaining, predicting and inducing behavior from the perspective of the health insurance customer journey.

Description: This panel discussion session focuses on filling the gaps in US health insurance including the identification of the uninsured & underinsured and proposed bills - catastrophic insurance, the Kennedy bill & NAICs Building Blocks proposal. 1979 Vol. 5 No. 3

Description: This panel discussion session focuses on developments in health insurance minimum loss ratio regulation including the NAIC Minimum Loss Ratio guidelines, loss ratios as a regulatory tool, and state regulatory actions. From Record of Society of Actuaries 1981, Vol. 7, No. 1.

Description: This 1981 session dealt with individual accident and health rate regulation issues. Topics included the history of regulations and their primary purpose or need. From Record of Society of Actuaries, Vol. 7, No. 2.