Description: The article documents the efficacy of infra-low frequency neurofeedback regarding how it improves patient no show rates, decreases mental health symptoms by 40% or more, and self-harm and suicidal ideations.

Description: Adding value in the development, production and marketing process of medical devises regulatory environment, designer/manufacturer perspective, product failure and litigation risk. Issue No. 44.

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: 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: 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: This article reviews the results of the first SOA study of large medical claims, defined as claims greater than $25,000.

Description: Actuaries have the business acumen, problem-solving capabilities, and technical skills to develop innovative and data-driven solutions in the social insurance space. It is time we expand our scope and embrace an increased role in making a positive impact within the health care ecosystem. The primary focus of this paper is on social insurance programs dedicated to the most vulnerable population: low-income families accessing care through Medicaid. While there are numerous challenges that require other subject matter experts to take the lead, this article highlights topics where actuaries can be key players in developing and implementing tangible solutions to improve the care for the most vulnerable. Issues and solutions in this paper focus on the following three areas: 1. Access to appropriate care, 2. continuity of care, and 3. social determinants of health.

Description: The impact of Medicare on retiree medical. Issue No. 44.

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: 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