Description: The editorial shares observations and lessons learned from the process of implementing the Affordable Care Act.

Description: In order to encourage health insurance issuers to offer health insurance coverage on the Exchange and on the individual and small group markets, while ameliorating the potential impact on any particular health insurance issuer of providing coverage without pricing for pre-existing conditions or the gender of the insured, the Affordable Care Act includes three risk-sharing programs: the Transitional Reinsurance program, the Risk Corridor program and the Risk Adjustment program (collectively referred to as the “3Rs”). The financial and tax reporting of each health insurance issuer is affected by the implementation of these risk-sharing programs because each health insurance issuer is required to pay for the programs’ costs, and some issuers are or will be eligible for benefits under them.

Description: Since health care reform has made accountable care organizations a hot topic, an SOA workgroup is addressing relevant questions, including provider risk under various ACO models, limitations of the Medicare model for motivating change in the health care delivery system, strategic priorities, attribution of members, meaurement, and the roles actuaries can play.

Description: Discussion of the impact of the ACA on RBS and required surplus for a health plan

Description: A proposal to address provider payment issues by gradually moving to accountable care organizations. Capitations would be risk-adjusted, non-capitated costs would be covered by hospitalization fund and stoploss, incentives for quality & effective preventive care would be tied to the amount remaining in the fund, and government involvement would be through incentives rather than mandate.

Description: A report on the proceedings of the June 2010 SOA health meeting. Leading topics included health care reform, opportunities to expand actuaries' roles, the global financial crisis, and collaboration with other organizations.

Description: A proposal to reform the health care provider payment system through: a national fee schedule, shifting more reimbursements to primary care providers, better integration of hospital & physician fees, evidence based care, pay for performance, and a better provider risk sharing mechanism.

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 article is a brief overview of what the Health Actuarial Research Initiative, HARI, is and what the participants in HARI will be doing. HARI is a project formed by the Society of Actuaries that will develop actuarial research studying changes in health care systems.

Description: The article looks back at the development of life protection product underwriting and pricing in UK. It describes the development in waves of change, looking at different drivers, e.g. consolidation of the life insurance industry, the role of technology as a driver for efficiency gains via electronic underwriting. Different levels of sophistication are being discussed and possible implications for the relationship between direct offices and reinsurers. This rather thought provoking article is based upon Munich research as well as market experience and ties in with a number of current topics as for example potential changes as a result of the Retail Distribution Review and the Gender Directive implementation.