Description: SOA 2012 Health Meeting Interview with Chairperson Daniel Bailey

Description: Regular column written by the chairperson of the Health Section Council.

Description: Summary of Medicaid encounter data, including how it is collected by health plans, transferred to state databases, used by states, and ultimately sent to CMS. The status of the CMS T-MSIS project is discussed, as well as the future of Medicaid encounter data as a source of information for many stakeholders.

Description: This article lists the top priority issues for SOA health committees for 2003 and their support for the Healthcare System in Crisis project, which is focused on giving the public an actuarial perspective on the dynamics and interrelationships of the healthcare system.

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

Description: This article is about the cost-benefit relationship of advances in longevity and taking personal responsibility for one's own wellness.

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.

Description: This article examines the costs of mental health parity, presents the primary drivers of cost increases from legislation and shows evidence the initial cost projections were too high. From Health Section News, March 2005, Issue No. 49.

Description: This article outlines what the author learned from the Sixth Annual Quality Colloquium at Harvard. From Health Watch, January 2008, Issue No. 57.

Description: With many pharmacy benefit plans now considering whether to add a 4th tier for high priced specialty drugs, review and discussion also needs to be given to the other end of the pharmacy cost spectrum to see how costs can be reduced by promoting lower cost over-the counter OTC drugs. From Health Watch News, September 2006, Issue No. 53.