Description: This is one of a series of SOA-sponsored papers on the subject of Evaluating the Results of Care Management Interventions. This paper addresses the theory of measurement design and provides a practical evaluation of the most common designs for the practitioner.

Description: As part of the SOA’s July 22, 2020, COVID-19 Virtual Symposium, Marketing and Distribution (MaD) Section Council members presented “Selling Insurance Six Feet Apart” with insight into emerging sales and marketing processes, challenges, and opportunities for the product spaces noted

Description: Can Direct-to-Provider Contracting Achieve Value-Based Care for Employer-Sponsored Plans? Direct-to-provider contracting is a strategy in which a self-insured entity negotiates a contract directly with a provider of healthcare services rather than through a third-party administrator (TPA), often with the goal of driving value-based care. This article discusses the considerations for employers and providers with direct-to-provider contracting.

Description: This article explores the disruptive applications of blockchain, an emerging technology, and its impact on the pharmacy benefit space, and pharmacy benefit managers (PBM).

Description: This article describes Medicare Supplement and short-term care products in more detail, and we compare their risk profiles. We explore the concept that these two products—when offered together—may provide a complementary hedge of certain policyholder behavior risks.

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: Discussion of how to mature value-based contracts between health insurers and provider organizations to improve population health and financial sustainability. Centers around contract parameter consistency, revenue predictability and risk assessment. Intended audience are health plan and ACO actuaries and leaders. Authors are writing from the provider perspective in value-based contracts.

Description: Current tax issues affecting the insurance industry, including the Inflation Reduction Act (Budget Reconciliation Bill)'s tax provisions, including the corporate minimum book income tax and share repurchase (or stock buyback) excise tax; the tax treatment of non coordinated benefits (also known as fixed indemnity benefits); and an update on the OECD’s Base Erosion and Profit Shifting Project

Description: What can the United States learn from other countries' health care systems? How are other countries more efficient? We selected five countries that have been among those debated as having some of the most efficient health care systems to explore what the United States can learn from these examples.

Description: In this editorial the author discusses how actuaries can help mitigate the impact of managed care lawsuits. Examples are provided. From: The Actuary, April 2000 – volume 34 - Issue 4.