Description: The SOA is seeking researchers to explore considerations within the LGBTQ+ community impacting employer-based health benefit designs. Review details on the background, research objectives, proposal requirements, selection process, submission guidelines, and project conditions.

Description: This article is an update on the No Surprises Act, which is a U.S. Act aimed to reduce the risk that a person unexpectedly receives out of network charges for their health care visits. This is Part 2; Part 1 was featured in Health Watch's Sept 2024 issue.

Description: Article reviews the data a year into the unwinding of continuous coverage provisions in Medicaid, the impact on enrollment counts, how capitation rates have been adjusted, and compares those results to what has been modeled with the SOA Mediciad Unwinding model.

Description: Cost is a key outcome metric used by actuaries and others to determine the value of a benefit or program in health insurance. However, typically, costs assessed include only the direct costs of the program, not any indirect costs or savings, such as those associated with reduced spending on other services.

Description: There is a big wave of changes coming to the pharmacy market. The extent is not yet fully known, but there are trends we can follow that help us predict. Biosimilar uptake is key to driving savings, but it can take a while to ramp up. Biosimilars bring competition, and this coming wave will bring unprecedented Biosimilar competition.

Description: Meditation on life, choices and events during the COVID-19 pandemic

Description: The Society of Actuaries Research Institute developed a new study to explore pharmacy financing. The goals of the SOA related to this research are to identify opportunities to increase transparency, encourage competition, align stakeholder incentives and mitigate increases in total cost of care. The research uses a value-based methodology.

Description: Health is wealth, but much needed medical insurance for various needs is perceived solely for the wealthy and elusive to many. This webcast brings two highly regarded speakers in the health sphere to bust the myth that medical insurance is reserved for the wealthy and only covers known illnesses. The discussions will further dwell on products that are designed based on financial capability and customized needs while transgressing on risks and sustainability of creative products such as mental health.

Description: Primary care is the backbone of health care service delivery and has been shown to contribute to positive health outcomes. Many states are emphasizing the importance of Primary Care by implementing new or expanded value-based purchasing arrangements. This session will explore recent developments in Primary Care payment models in Medicaid, how they align with initiatives from other payers, and how they address health equity.

Description: Risk adjustment (RA) is a key component for CMS Medicare Advantage program and California Medicaid Managed Care program. While both RA programs follow generally accepted basic principles at a high level, their underlying methodologies and assumptions are also quite different. Due to recent events such as COVID-19 Public Health Emergency and Medicaid redetermination delay and restart, it adds complexity to Risk Adjustment. This is a hot topic in the industry and has significant impact to health plans. Keeping current with risk adjustment program changes and understanding the commonalities and differences of these two government risk adjustment programs is important to our health actuaries. Compare these two risk adjustment programs so you can learn key elements of a risk adjustment program, similarities and differences in methodology and assumptions , as well as special considerations due to serving different populations.