Description: ACA risk adjustment is intended to "bridge the gap" between allowed rates and actuarial rates. If risk adjustment methodology is not bridging that gap & becomes an additional input to pricing formulae, it is not serving its intended purpose.

Description: This article discusses a study of the impact of the drug infliximab on Crohn's disease patients. This study had been approved in response to an SOA request for proposals for research on the health cost and utilization effects of a specific prescription drug.

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: Summary of the 1974 report of the HIAA Prevailing Health Care Charges System which contains data from about 900,000 charges for up to 1,600 different surgical procedures, summarized for 250 geographical areas. From The Actuary Vol. 9, No. 7

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.