Description: Risk Adjustment continues to be a hot topic in Health Insurance since its emergence. This mechanism came into being as a means of reducing the risk of selection, particularly in marketplaces where underwriting is not allowed, and rating factors are significantly restricted. Risk adjustment serves to adjust premiums to reflect the risk of individual members or overall members as a whole within a particular cohort of a health plan. Risk adjustment is not perfect, as it does not perfectly predict future costs or perfectly adjust for the differences in expected costs. Different marketplaces have different challenges with risk adjustment.

Description: The momentum in value-based care has produced an opportunity for actuaries to become pioneers in health care

Description: The Society of Actuaries (“SOA”) Research Institute is the research arm of the SOA, providing objective, data-driven research that brings together tried and true practices and future-focused approaches to address societal challenges and business needs. The Institute provides trusted knowledge, extensive experience and new technologies to help effectively identify, predict and manage risks.

Description: The Society of Actuaries (“SOA”) Research Institute is the research arm of the SOA, providing objective, data-driven research that brings together tried and true practices and future-focused approaches to address societal challenges and business needs. The Institute provides trusted knowledge, extensive experience and new technologies to help effectively identify, predict and manage risks.

Description: The COVID-19 pandemic helped accelerate many changes in the Health Care system that were already taking place. The major disruptions to the way providers operated was quite evident with shifting of focus away from elective services to create capacity for treating COVID-19. However, even before the pandemic, providers were adapting to changes in their environments.

Description: The implementation of the IFRS 17 insurance accounting standard has brought significant changes to the financial reporting landscape of insurance companies. With new disclosure requirements and altered profit analysis, understanding and interpreting future profitability have become a topic of concern for the industry. While stability remains a key objective for insurance companies, the earning patterns might become more volatile especially when the contractual service margin (CSM) is exhausted, and a loss component (LC) needs to be established. Reinsurance, a common risk mitigation tool, can play a pivotal role in managing earnings volatility and minimizing losses for onerous measurement units. In this article, we propose a new key performance indicator (KPI) called “loss recoverability” to assess the performance of reinsurance treaties in achieving these objectives. We explain how this KPI can be utilized in multiple scenarios to evaluate the effectiveness of reinsurance strategies and pursue stability in earning patterns.

Description: This article is intended to inform readers about the current state of mental health and health care in the US, as were it's heading moving forward.

Description: Discover the key components of value-based care (VBC) contracts and their impact on provider credibility. Learn about benchmarks, measurement period results, and the unique challenges providers face in managing insurance risk. Gain insights into reducing costs and aligning financial incentives in the US healthcare market.

Description: Interview on opportunities for InsurTechs in Life and Health reinsurance. Themes covered include digital distribution and digital health data. The article also shares insights into the role of the reinsurer when working with InsurTechs.

Description: Panelists from the home-based care industry will discuss the latest technology and services that enable and prolong the receipt of formal and informal care at home for the elderly and delay transitions to care facilities.