Description: Medicaid and the ACA

Description: Article from the Daily Herald on the subject of pandemics.

Description: The proposed session will introduce Outcome Based Risk Sharing Arrangements (“OBRSA”) between health insurance payers (“payers”, including insurance companies, health plans, sponsored employers, and government programs) and pharmaceutical manufacturers (“pharma”), and it’s intended to meet the needs of actuaries who focus on pharmacy benefits and risk sharing arrangements. The covered content will include (1) the background of OBRSAs, definitions, stakeholders, and OBRSA’s role in shifting the system from volume-based toward value-based; (2) conflicting perspectives about OBRSAs between payers and pharma (cultural and methodological); (3) identification of incentive gaps between payers and pharma, and incentive alignment between them; (4) barriers to implement OBRSAs; (5) limitations and considerations of OBRSA implementation; and (5) hypothetic OBRSA examples.

Description: Letter from the Editor

Description: Read the March 2017 issue of Health Watch, published by the Health Section. Practical information for actuaries, articles impact sections, section activities.

Description: Description of and reasons for Health Section strategic initiative relating to self insurance

Description: The CMS Risk adjustment model allows actuaries to apply our analytical skills and business knowledge to solve risk and revenue challenges within Health Plans.

Description: The value-based ERM approach is a robust yet practical synthesis of enterprise risk management and value-based management, and has been used to help a range of companies – financial services companies, non-financial services companies, and non-corporate entities alike – successfully implement their ERM programs and integrate ERM into their decision-making processes.

Description: This report summarizes the key findings and data points from the selected articles. Included for each article are the report’s abstract along with any empirical data available from the study that can help support an actuarial model that identifies the relationship between lifestyle behaviors, health risk conditions and health outcomes.

Description: For the top-20 key risks, the carriers were asked to identify the key risk indicators (KRIs) they use for monitoring and the activities they use, or plan to use, to mitigate the likelihood of occurrence and/or the severity of impact.