Description: The level-funding approach to medical stop-loss insurance is growing in popularity, yet is highly specialized. This session will give the actuarial community an overview of level-funding, including the basic mechanics, the benefits of offering level-funding to clients, and the five keys to success, including the ability to underwrite this specialized coverage.

Description: Critical illness insurance is a popular supplemental health insurance product in the U.S. market. This article discusses how carriers have recently sought to add value by expanded the benefits offered in their critical illness products. Specifically, the article discusses the consumer need and development considerations of adding benefits for autism Spectrum Disorder, Mental health disorders, Specified Disease Coverage, and enhance Cancer Coverage to a critical illness contract.

Description: Discover the key components of value-based care (VBC) contracts and their impact on provider credibility. Learn about benchmarks, measurement period results, and the unique challenges providers face in managing insurance risk. Gain insights into reducing costs and aligning financial incentives in the US healthcare market.

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: This article attempts to make a modest contribution to the dialogue on the potential and risks associated with novel treatments such as cell & gene therapies. With a fast-expanding roster of what are believed to be one-time treatments at ever increasing price points aimed at curing a wider swatch of the population, they are as much a source of relief for patients stuck in medical limbo, as they are a source of anxiety for payers.

Description: Learn about key actuarial and analytic tools and methodologies used by commercial health insurance to identify and quantify drivers of healthcare cost and utilization (including wasteful and low-value ones) and risks. Use case scenarios in which these tools and methodologies apply, such as underwriting, reinsurance, medical management for population health and chronic diseases, managed care contracting, insurance market reform, provider payment reform, etc., will also be covered. Experience from the U.S., China and other parts of the world will be shared.

Description: The COVID-19 pandemic helped accelerate many changes in the Health Care system that were already taking place. The major disruptions to the way providers operated was quite evident with shifting of focus away from elective services to create capacity for treating COVID-19. However, even before the pandemic, providers were adapting to changes in their environments.

Description: Telehealth benefits, obstacles, and delivery systems

Description: The momentum in value-based care has produced an opportunity for actuaries to become pioneers in health care

Description: The Society of Actuaries (“SOA”) Research Institute is the research arm of the SOA, providing objective, data-driven research that brings together tried and true practices and future-focused approaches to address societal challenges and business needs. The Institute provides trusted knowledge, extensive experience and new technologies to help effectively identify, predict and manage risks.