Description: The Affordable Care Act (ACA) changed the health insurance value proposition for lower-income Americans. Consequently, the uninsured rate has dropped dramatically since the implementation of ACA marketplaces and the expansion of state Medicaid programs to a broader eligibility group. It is not difficult to connect the change in financial dynamics to the increase in health insurance coverage. At the same time, many Americans remain uninsured due to non-financial barriers. Identifying solutions to further reduce the uninsured rate is more difficult than intuitively 'spending more federal money'.

Description: Since the Affordable Care Act implemented minimum loss ratio provisions for health plans, several states have passed or at least considered minimum loss ratio regulation for dental plans. While such regulations are intended to improve insurer efficiency and promote value to consumers, they can have unintended negative consequences if the unique characteristics of the dental insurance market are not considered. Learn about this hot topic, including loss ratio basics, recent legislative activity in the dental loss ratio space, how dental differs from medical, and why those differences are critical to account for when trying to regulate loss ratios in that market.

Description: This document is a Request for Proposals (RFP) outlining a proposal request on the impact of the U.S. drug abuse epidemic on mortality, focusing on opioids. It provides details on the background, purpose, research objectives, proposal requirements, selection process, and conditions for submitting a proposal.

Description: A Request for Proposals (RFP) for research studies on the impact of climate change and catastrophes on the U.S. health infrastructure. It outlines the background, objectives, submission requirements, and selection process for potential researchers.

Description: During the past few years, performance, cost, and risk trends for Medigap products have undergone substantial changes. Some of these trends could ease cost pressures on Medigap insurers, while others might increase them. Part 1 of this Issue Brief article discusses current changing trends and considerations around about how they are impacting Medigap.

Description: Prescription drug affordability remains a critical concern for consumers, payers and policymakers alike. This paper discusses an alternative to policy solutions: reimagining commercial pharmacy financing using a value-based reimbursement model to increase transparency, encourage pharmaceutical competition, align stakeholder incentives and mitigate total cost of care (TCOC) increases.

Description: "Direct medical costs for cancer care topped $209 billion nationally in 2020, accounting for a significant proportion of all health care expenditures in the U.S. Indirect costs are also significant, encompassing loss of productivity, wages, leisure time and decreased quality of life. The way cancer programs deliver and are reimbursed for care is rapidly changing. As the cost of cancer care continues to rise, several new value-based care programs - both public and private - have attempted to curb these rising costs. Learn about the current landscape of VBC oncology programs, several key challenges and opportunities with oncology analytics, as well as anticipated evolution of cancer care in the near future. Topics include: Current VBC oncology landscape, including a more detailed discussion on CMS' latest oncology program, Enhancing Oncology Model (EOM) Discussion on current challenges and opportunities with oncology analytics, including some advanced methodologies that have been developed based on documented clinical pathways to better understand cost drivers Future state of oncology care including emerging pharmaceuticals and novel therapies, personalized care regimens, and other clinical innovations"

Description: The Part D program is funded through a variety of government subsidies and manufacturer discounts. The federal reinsurance, initially designed as protection from catastrophic spending, became a primary source of subsidies for the program. When the Inflation Reduction Act (IRA) is fully implemented in 2025, the funding of Part D will realign to its original intent.

Description: The Society of Actuaries Research Institute developed a new study to explore pharmacy financing. The goals of the SOA related to this research are to identify opportunities to increase transparency, encourage competition, align stakeholder incentives and mitigate increases in total cost of care. The research uses a value-based methodology.

Description: "Are you a health actuary affected by recent developments in business practices and accounting standards that have created situations in which you may be involved in estimating balances under accounting rules that differ from those typically used by insurers? In this session you will learn about situations where non-insurance accounting regimes may intersect actuarial practice, with an intended focus on two particular topics. One topic is general accepted accounting principles (GAAP) for insurance brokers under ASC 606 (Revenue Recognition) for commissions on Medicare Advantage and Medicare Supplement contracts, where the broker may get to recognize the expected value of all future commissions on a contract as revenue when the contract is placed. The other topic is GAAP under ASC 460 (Guarantees) in situations where a non-provider entity is bearing risk related to health care services, which can occur under the CMS Direct Contracting/ACO REACH model or under private sector care coordination contracts."