Description: Actuaries have the business acumen, problem-solving capabilities, and technical skills to develop innovative and data-driven solutions in the social insurance space. It is time we expand our scope and embrace an increased role in making a positive impact within the health care ecosystem. The primary focus of this paper is on social insurance programs dedicated to the most vulnerable population: low-income families accessing care through Medicaid. While there are numerous challenges that require other subject matter experts to take the lead, this article highlights topics where actuaries can be key players in developing and implementing tangible solutions to improve the care for the most vulnerable. Issues and solutions in this paper focus on the following three areas: 1. Access to appropriate care, 2. continuity of care, and 3. social determinants of health.

Description: Review of non public options to finance care including personal savings, revers mortgages, family care and private insurance.

Description: Following recent SOA Research, we look at how climate scenarios will affect Long Term Care assumptions and business.

Description: This study would assess the impact of recent patient care innovation(s) on health care and the health insurance industry.

Description: Family caregivers are a critical link in providing long-term services and supports (LTSS), but they have significant unmet needs. To better support family caregivers, Congress authorized the Recognize, Assist, Include, Support, & Engage (RAISE) Family Caregivers Act in 2018 and created the RAISE Family Caregiving Advisory Council. The Council identified recommendations to serve as the backbone of a national strategy to improve the physical, emotional and financial well-being of family caregivers. A new report, "Asking Directions: Mapping a Course to Support Family Caregivers," identifies specific actions across a variety of players for meeting the Council’s recommendations. It summarizes insights from a year’s worth of strategy sessions and interviews with representatives of over 100 organizations. The report brings together thoughts on best practices and the most critical action steps from national and state organizations, county health providers, the direct care workforce, large and small employers, aging and disability organizations, faith-based groups, respite care providers and more. This article summarizes the research methods and key findings of the report and the work conducted by the Leading Age LTSS Center @UMass Boston and Community Catalyst’s Center for Consumer Engagement in Health Innovation.

Description: Description * Coinsurance has not been widely offered as a benefit reduction option to offset long-term care premium rate increases. This article uses an illustrative example to evaluate the potential impact coinsurance could have on an insurance carrier's future claim liabilities and a policyholder's premium rates. It also explores various considerations insurance carriers, regulators, and policyholders should think about when evaluating whether coinsurance is the right option.

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: This article details the medical stop-loss coverages purchased by HMOs, small insurers and providers taking delegated financial risk in payor agreements. Along the way we will identify strategies purchasers often use to save money on medical stop-loss.

Description: The article describes a new professional experience course in actuarial science at the University of Toronto, including details on its key building blocks and student assessments. It also discusses different teaching modes (in-person vs. online). It should be of interest to institutions looking to add industry internships and experiential learning into their actuarial education.

Description: ACA risk adjustment is intended to "bridge the gap" between allowed rates and actuarial rates. If risk adjustment methodology is not bridging that gap & becomes an additional input to pricing formulae, it is not serving its intended purpose.