Description: Article describes enhanced primary care models and provides citations on whether or not health care savings have been achieved.

Description: On March 6, 2023, The Wall Street Journal hosted its Health Forum, a hybrid all-day event. The virtual meeting featured 11 different events. This white paper focuses on those events. The sessions were informative and fast-paced, with each one providing a quick hit of relevant and cutting-edge information around health care.

Description: This session is about rationing health care. From Record of Society of Actuaries Vol. 18, No. 4A.

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: 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: This session is about managed-care risk-sharing arrangements. Topics include insurance company and HMO joint ventures, employer arrangements with insurance companies and HMOs, and HMO provider risk contracting. From Record of Society of Actuaries Vol. 19, No. 1B

Description: Presented at October 2001 Annual Meeting. Discusses three key factors related to catastrophic health care events: • Trends in health care delivery and medical technology that are likely to impact catastrophic care costs • Methods of cost and risk control through early identification and specialized medical management • Modeling the cost of catastrophic events on health insurance programs

Description: A dicussion of the Rate Classification Actuarial Standard of Practice, ASOP #12: its purpose, its scope, guidance, and examples.

Description: Yi-Ling Lin, FSA, MAAA, FCA, started the SOA’s Predictive Analytics Certificate Program to keep pace with the impact big data and predictive modeling is having on the health care industry

Description: On January 1, 2014, many states will be enrolling newly eligible parents and childless adults into the Medicaid program. This article compares the expansion population to the current Medicaid population.