Description: This session discussion is about under 25 life group medical reform, model bills, state variations, congressional proposal, community rate implications, effect of RBRVS on provider fees and plan cost. From Record of Society of Actuaries Vol. 17, No. 4A.

Description: This presentation is a Health Section meeting from the 1991 Annual Meeting of the Society of Actuaries, held October 20-23 in Toronto. The session leader, the incoming chair of the section, covers administrative matters, and then the next speaker addresses a newly completed research project, sponsored by the Society and Health Section, on the variation by duration in small group medical insurance claim costs. The speakers then discuss current developments in small group reform, and the various parties involved, including the National Association of Insurance Commissioners [NAIC], and the Health Insurance Association of America [HIAA], and the work that has been done, including modeling to address the impact of a small group reform mechanism. The speakers discuss how the various parties' objectives can differ. Discussion from participants is included. From the Record of Society of Actuaries, Volume 17, No. 4B.

Description: Summary of results of a 2010 Health Section survey of actuaries and Medicare population, on ways to bend the cost trend curve downward. Issues included transparency, quality measures, fraud and abuse, provider payment, malpractice, medical errors, consumer education, and the pros and cons of employer-sponsored coverage.

Description: This session dealt with Regulatory Considerations in Group Insurance. Topics included: 1. National health insurance. 2. Federal hospital cost control programs. 3. Non-discrimination legislation and regulation. 4. Multiple- employer trusts. 5. Impact of recent OASDI financing changes. 6. Changes in mandatory retirement age on group insurance.

Description: Transcript of the Q&A period from Session 6B: Health Status and its Impact on Mortality

Description: This session explores the far-reaching changes to how clinical data will be sourced, processed and consumed in many payer use cases including risk adjustment, quality measurement, care management, claims adjudication, prior authorizations, and other payer functions. Robust, interoperable data exchange is a prerequisite for value-based care. Clinical data will be increasingly accessible to augment administrative (claims) data via standardized Fast Health Interoperability Resources (FHIR, pronounced 'fire'), at a fraction of the cost of a accessing a traditional medical record and in real-time. On May 1, 2020, HHS issued a final rule implementing interoperability and the patient access provisions of the 21st Century Cures Act of 2016, although enforcement has been delayed into 2021 because of the COVID-19 pandemic. The new regulations promote, “HHS’s vision and strategy for achieving a health information ecosystem within which all individuals, their personal representatives, their health care providers, and their payers are able to send, receive, find, and use electronic health information in a manner that is appropriate, secure, timely, and reliable to support the health and wellness of individuals through informed, shared decision-making, as well as to support consumer choice of payers and providers.”Once enforcement begins, CMS and the Office of the National Coordinator for Health Information Technology (ONC), have the authority to mandate adoption of interoperability requirements, and also penalize payers and providers for non-compliance or the delay and withholding of data.This ‘digital transformation’ of the clinical data ecosystem has far-reaching implications for enabling technologies including Natural Language Processing (NLP) and entire segments of services and vendors. It will eliminate many departmental barriers, duplication and error sources for health plans and impact every department and the underlying economics of delivering and managing care.

Description: Developing a formal strategy to guide the SOA’s activities with respect to public policy-related topics is underway. Recent experience shows that non-partisan contributions through the SOA’s research are already adding value to important public policy discussions.

Description: The author attempts to weave together biological and environmental explanations into the mathematical approaches developed over the past two centuries so as to, in the words of two earlier authors from the actuarial profession, reground the relationship of actuarial science with cellular biology and gerontology. Also examined is the extent to which increasing wealth and higher standards of education and health contribute to happiness.

Description: Results of an SOA survey regarding the expectation for 2015 accruals for 3Rs and cost sharing reduction payments.

Description: Results of an SOA survey regarding the expectation for 2015 accruals for 3Rs and cost sharing reduction payments