Description: The resumption of Medicaid redeterminations following the conclusion of the COVID-19 Public Health Emergency (PHE) represents a significant disruption across multiple lines of business in the health care market. While there has been much uncertainty regarding the timing and pace of the resumption of redeterminations, 2023 is beginning to bring clarity to the myriad questions posed by states, employers, managed care organizations (MCOs), and other interested stakeholders. Begin with a brief review of the latest developments regarding the end of the PHE and resumption of Medicaid redeterminations. Then, transition to a panel discussion on the various impacts that key stakeholders are starting to see, and expectations for short-term and long-term impacts to programs, plans, and businesses.

Description: This paper helps the audience understand the actuary’s role in estimating the financial impact of primary care programs. In addition, the paper can be used by actuaries to think about key issues when estimating the financial impact of their employers’ and clients’ own primary care programs.

Description: This report summarizes thoughts and questions about the impact of COVID-19 on working in retirement, phased retirement and how the definition and timing of retirement may change. It provides a synthesis of the expert input mentioned above and offers background on related research results. It also describes other issues for further consideration. T

Description: This study estimates the number of COVID-19 confirmed cases and reported deaths by hospital referral regions (HRR) using Johns Hopkins University COVID-19 data by U.S. county and the Dartmouth Atlas Project division of counties into HRRs.

Description: This is a Request for Proposals (RFP) issued by the SOA Research Institute (SOARI) seeking research studies related to anxiety, depression, and their impact on mortality in the United States.

Description: Inflation and the possibility of recession are major factors affecting health care cost increases over the next five years. Insurance and medical organization will continue to evolve but are unlikely to create major shifts in the short run. However, over the long run structural changes in providers and payment mechanisms will determine future trends – raising or lowering the health share of GDP depending upon public choices and private decisions.

Description: The Society of Actuaries (SOA) published its first COVID-19 research brief on March 10, 2020, followed by regular updates and expansions through June 12, 2020. The comprehensive report included a section of Key Statistics. This report provides updates to some of the data from the Key Statistics section of the brief and additional related data, organized by geography.

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: There are many ways to actively utilize BE approaches – and implementing these important tools can help insurers in many ways.

Description: PBMs are positioned in the healthcare delivery system as the only entity that is not regulated for profitability. The Commercial Fully Insured Health Insurance Plans are heavily regulated by the State Insurance Commissioner who allows only 2%-3% profit margin. The self-funded Health Plans are regulated by ERISA fiduciary responsibility that prohibits excessive compensation. PBMs are classed as a service provider and are not regulated by either. This allows PBMs to implement large, unreasonable mark ups for profit. PBMs are massive commercial entities, states are trying to sue under antitrust law. PBMs found a sweet spot in the regulation. Large Insurance Carries understood that and either acquired large PBMs or merged with them. It is likely that a combination of measures will be needed to regulate PBMs. The most direct approach would be for Congress to pass a law establishing PBM as a fiduciary under ERISA just like an “investment advisor” providing advice for a fee. Establishing PBM as a fiduciary will help Courts and other Federal Agencies ensure that PBMs do not unfairly retain rebates and inflate the prices of Rx drugs sold to employer health plans, and the US population in general.