Description: Direct Primary Care (DPC) is a newer model of primary care delivery in which patients or employers pay for care directly on a membership basis; insurance and other third-party payment is not used. Early studies show significantly improved patient health outcomes and lower expenditures for DPC patients compared with similar patients receiving traditionally delivered primary care. Additional research is needed to better understand physician perspectives about the model and the role of patient selection in early results.In this session we discuss research projects that may shed light on the DPC model and on whether early results indicate more about the model or about the patients who use it.We discuss an SoA research project that interviews DPC physicians to better understand their views about the model and its early results. We also discuss a paper that analyzes characteristics of patients who receive primary care from a DPC physician and compares them to characteristics of patients who receive primary care in more traditional ways. This cross-sectional study surveys all adult patients of a convenience sample of several DPC practices. Variables include demographics, socio-economic status (SES), type of additional coverage (if any), whether DPC fees are paid by an employer, and self-reported health status. The Medical Expenditure Panel Survey is the main source of comparison data. For a given cohort of demographics and additional coverage, we determine whether DPC patients have similar health status, demographics and SES as non-DPC patients. This study will provide insight into the degree of selection into DPC by observable patient characteristics.

Description: This speaker, President of the Health Insurance Assoc. of America, examines the future of private health insurance in the US. From Record of SOA, 1979 Vol. 5 Nol. 3

Description: This session covers the economic principles of “buffet pricing” and whether such pricing can be used for health care. Presented is an argument in favor of “all you can eat” pricing of health care where consumers pay a fixed fee and have no constraints on consumption. From the Record of the Society of Actuaries, Volume 27, No. 1, Session 118

Description: Responds to questions received during the webcast with regards to modeling long term medical trends for valuation purposes. Questions cover testing the model against publicly traded companies, the calculation of growth rate in the model, the income multiplier as the population ages, model relevance to Canada, factoring in of extra disease burdens, exclusion of aging in the model, and the effect of the globalization of health care.

Description: This session discussed about expected trends in medical care costs, changes in Medicare reimbursement practices and their short- and long-term effects, the emerging responsibility for providing long-term care, rise of managed health care, new and old participants, selection issues, multiple options, and small group market.

Description: Panel discussion exploring likely future scenarios, encompassing: Balance between state and federal regulation, effects of trends in tax regulation, and implications of all-federal or all-state regulation. From Record of the Society of Actuaries Vol. 12, No. 2.

Description: Health care is a complex market with a wide variety of stakeholders. These stakeholders have diverse business needs, requiring complicated data-driven decisions. The analytics and research supporting these decisions are often dependent on the availability of real-world data (RWD), which includes a wide variety of data capture technology and data reflecting treatment, clinical outcomes, and costs of health care in real treatment settings (e.g.,, outside of controlled clinical trials). The goal of this panel discussion is to explore how existing and emerging sources of RWD can enhance benefit design, improve risk assessment, influence treatment decisions, and advance the measurement of clinical, humanistic, and financial outcomes. The diverse speaker panel includes actuarial and non-actuarial perspectives, representing the pharmaceutical industry, a health-care services business, and academia. The panel will describe the decision-making that drives their individual needs to use RWD, identify current and developing RWD sources, provide examples of analyses using RWD, and discuss how emerging RWD may influence actuarial analytics and potentiate the development of new interdisciplinary methods and value drivers.

Description: Panel discussion of prospects for cost containment of, and alternatives to, fee-for-service health care, and management of health care under national health insurance. Discussion points include cost containment devices, HMOs, economic impact, cost escalation, self-insurance, stop-loss, claims administration, loss of state premium taxes, and Phase 3 tax problems under NH1.

Description: Update on the potential impact of national health law legislation, and discussion of the influence of inflation on both the relation between actual and expected claims, and the design of new benefits and administrative procedures. This presentation was made at the 1975 SOA Los Angeles Spring Meeting.

Description: Panel session discussion of how universal access, quality of care, and controlling health care costs are being addressed in Latin American countries.