Description: This session discussion is about under 25 life group medical reform, model bills, state variations, congressional proposal, community rate implications, effect of RBRVS on provider fees and plan cost. From Record of Society of Actuaries Vol. 17, No. 4A.

Description: The Health Care Cost Institute (HCCI) recently released their annual health care cost and utilization report on February 13, 2020. This report illustrates employer group commercial health care costs and trends from 2014 – 2018.

Description: This presentation from Session 100PD of the SOA 1999 San Francisco Annual Meeting is about the evolution of medical underwriting: where we've been, what we've learned, where we are, and where we go from here. The panelists also discuss the role and purpose of underwriting in the individual market, how societal attitudes have changed, and the resulting legislative challenges to industry practices. Specific states with 'innovative' requirements [New York and Florida, for example] and the resulting impact on the health care markets in those states are reviewed. Current topics include proposed limits on HIV testing, genetic testing, issues surrounding privacy and confidentiality, the impact of guaranteed issue, and community rating in the marketplace. From the Record of the Society of Actuaries, Vol. 25, No. 3.

Description: How does where you live impact your health? The following research considers this question through the lens of social determinants of health (SDOH), which are factors relating to where you live or work that may impact your health. In the United States, there are geographical differences in SDOH which contribute to wide disparities in health status and outcomes. In particular, individuals who are negatively affected by SDOH may have an increased burden of disease, leading to a relatively high total cost of care and worse quality of life.

Description: Article reviews the data a year into the unwinding of continuous coverage provisions in Medicaid, the impact on enrollment counts, how capitation rates have been adjusted, and compares those results to what has been modeled with the SOA Mediciad Unwinding model.

Description: The presenters will provide updates on research being conducted under SOA sponsorship. This includes projects on the topics of Direct Primary Care and Patient Centered Medical Homes.

Description: Healthcare costs have been rising faster than general inflation for many years. Early models that predicted this past pattern projected healthcare expenditure growth that continued to outpace total expenditure growth leading to the fallacious position that the whole of the US economy would ultimately be consumed by healthcare. This paper presents a long term healthcare trends resource model, prepared for the Society of Actuaries by Professor Thomas Getzen, that includes capacity constraints to ensure the long-term projection is rational. The motivation for creation of the model was driven by its potential usage as a resource for the estimation of reportable liabilities for retiree healthcare benefits as specified under FAS 106 and GASB 45 accounting statements.

Description: Through the sponsorship of the Robert Wood Johnson Foundation, The Society of Actuaries partnered with Wakely to use their health care data to study the effects of COVID-19 on overall health care claims for individuals with a COVID-19 diagnosis. The conclusion of the study is that individuals with COVID-19 claims had significant increases in health care costs leading up to their months of diagnosis, as well as in the months following their diagnosis. These effects were more pronounced for individuals who were hospitalized due to COVID-19 as well as for individuals with prior co-morbidities. Finally, the overall health care costs of these members plateaued at significantly higher levels than their pre-COVID baselines. In fact, all the main membership cohorts experienced claim levels that were at least 20% higher than their pre-COVID starting points.

Description: Cell and Gene Therapy (CGT) are life-changing treatments where conditions such as cancer, hemophilia, spinal muscular atrophy and blindness are being cured. These are great for individuals and society, but the treatment costs are expensive which is bad for payers and reinsurers. This article explores ways for health reinsurance actuaries to participate in the space and evaluate the risk associated with these treatments

Description: Supplemental Appendices for Using Social Determinants to Identify Profiles of U.S. Children with Low Dental Expenditures and High Medical Expenditures with Clusters