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: 1992 SOA Regional Meeting, Chicago. This discussion is about direct marketing growth in the 1980s, sustaining the growth in the 1990s, regulatory constraints in the 1990s, impact of continuing production cost increases, new product designs, and declining response rate.

Description: Align carrier, agent, and consumer definition(s) of DTC to establish a collective understanding for the affected parties. Understand why a direct-to-consumer approach may be important for carriers’ and distributors’ growth and development goals, tactics and strategies. Use the agreed-upon baseline and understanding of DTC’s importance to establish and agree upon reasonable expectations for its role in marketing, distribution, and product development and performance. Position carriers and distributors together to align sales, marketing and performance expectations and incentives for all parties to increase the possibility of outperforming in (and outside of) the DTC space; design sales, marketing and distribution systems and approaches to meet consumers where they are at; and expand current sales and cultivate new markets to remain relevant and magnify profiles in an ever-changing industry.

Description: Feature article discussing the impact of health care reform on the direct insurance market and the reinsurance market.

Description: In today’s marketplace, consumers are driven by research, reviews and ease-of-use more than before. They want to be empowered in their buying decisions and are turning their backs on insurance agents as the source of information for their buying decisions. The direct-to-consumer (D2C) platform addresses the expectations of the modern consumer and provides an opportunity for insurers to automate and execute underwriting in real time with better results than has been seen with traditional processes—and at significantly lower costs. D2C not only helps insurers by improving processes, reducing costs and maximize sales; it can also be used to provide a range of services through an online platform to increase customer engagement. Driven by the need to remain competitive and against the threat of new entrants, insurers foresee extensive use of direct-to-consumer channels as an alternative distribution method. However, to remain competitive they must throw away their outdated thinking and become future-oriented in the acquisition of customers. This starts with understanding D2C models in the insurance industry.

Description: Actuaries are currently familiar with the impact of new technologies used primarily by clinicians and health care providers, such as new drugs and devices. The common theme emerging from many of the articles points to a technological revolution in health care accelerated by the COVID-19 crisis this year. Actuaries need to understand these technologies, their impact, learn how to drive this technological change and guide the response of their profession and their own health care organizations.

Description: This session will provide information about the current landscape for employer to provider direct contracting. We will discuss the number and types of the most prevalent direct contracts and provide a forum to discuss the likely future direction of these arrangements with point of view consideration from employers, providers and payers.

Description: Answers to questions that have surfaced with regard to recent trends in the use of psychiatric medications, including relative effectiveness compared to prescribing patterns, drivers of prescribing patterns, classification and indications for recently publicized drugs, role of primary care providers, preventive use ofdementia medications, and new developments in the field.

Description: When compared to 10 developed countries, the US ranks last in overall health care performance, highlighted by per capita spending that is 50% greater than the next country and last place rankings in efficiency, equity, and healthy lives. Escalating costs and decreasing affordability continue to pose the primary challenge in U.S. healthcare as cost pressures are increasing for all who pay for healthcare: health plans, governments, employers, and consumers. From 2010 to 2015, the average health plan medical loss ratio increased from 86% to 90% and average employee contributions to premiums increased by 24%. This session will investigate how health plans could bend the cost curve by focusing on solutions such as medical/Rx cost reduction opportunity assessments, VBC maximization, PBM relationship maximization, care model redesign, provider/health plan collaboration, and next generation product design.

Description: Efforts to improve health in the United States have traditionally focused on the health care system. While the Affordable Care Act (ACA) expanded access to health care, research demonstrates that improving population health will require broader approaches that address disparities in health and health care, as well as social, economic, and environmental factors: the social determinants of health. These elements of health equity -- the social, economic, and physical environments in which we are born, live and work -- profoundly affect our longevity and health. The webcast will review one health insurer's research into many of these disparities and will discuss what we as health care professionals can do improve health equity for the populations we serve.