Description: Social Determinants of Health (SDOH) include the social and physical conditions in which people are born, live and work on a daily basis. This project advances a growing body of literature to inform the ongoing optimization of population health and payment models.

Description: This is a brief report that summarizes recent changes in the prevalent medical loss ratio methodologies and also looks at some of the more recent experience of health insurers that filed medical loss ratio reports.

Description: In the past months, as COVID-19 has forced the reduced activity in the U.S. economy there has been some very substantial, but varied effects on the U.S. healthcare system. There is a lot of potential for confusion amongst providers and patients with regards to decisions related to which services ought to be rendered and which ought to be deferred. Two specific agencies – the Centers for Medicare and Medicaid Services (CMS), and the American College of Surgeons (ACS) have put together some guidance to add more clarity towards what types of services should be provided and what types ought to be deferred. In addition, this paper includes a discussion on what types of services are most likely to be deferred, and which ones will accrue pent-up demand to be released when many of the deferred services become available again.

Description: Healthcare risk adjustment methodologies have become increasingly complex, largely due to the belief that complexity enhances accuracy. However, a disconnect exists between how healthcare risk is assessed and how payments are adjusted. This article explores the stark difference between measuring the accuracy of a risk assessment model at a member level, and that of a risk adjustment mechanism at the health plan level. I show that a highly simplified approach that does not use diagnosis codes can have similar accuracy on risk adjusted payments to models that do. These findings suggest that accuracy is not a barrier to developing simpler risk adjustment methodologies, which can improve payment accuracy and reduce the financial incentive for coding diagnoses.

Description: This Society of Actuaries, working with LIMRA, Oliver Wyman and the American Council of Life Insurers, is releasing a series of pulse surveys aimed at obtaining a quick read on how the COVID-19 pandemic is impacting insurance companies and reinsurers.

Description: A Brief covering the impact of COVID-19 on mental health.

Description: In 2018, the Financial Accounting Standards Board (FASB) adopted significant revisions to the U.S. GAAP insurance accounting literature, via Accounting Standards Update (ASU) 2018-12. The title of ASU 2018-12 is “Targeted Improvements to the Accounting for Long-Duration Contracts,” and as a result a common acronym for ASU 2018-12 is LDTI (long-duration targeted improvements).

Description: The purpose of this document is to inform the user of the 2021 Health Care Cost Model about the sources of data, other reports, and assumptions which were used to populate this report and drive some of the key considerations.

Description: A Request for Proposals (RFP) for research studies on the impact of climate change and catastrophes on the U.S. health infrastructure. It outlines the background, objectives, submission requirements, and selection process for potential researchers.

Description: Two years ago, before COVID-19 changed everything about how we provide and receive health care, telehealth was largely provided by third-party vendors to treat a narrow range of acute one-and-done conditions. The value proposition was simple: a fast and easy member experience would drive satisfaction and engagement; high member satisfaction and engagement would drive health plan savings and member retention. Clearly, from the perspective of utilization, telehealth—as a viable alternative to in-person care during a pandemic—worked. And with COVID-19’s nudge—or was that a push?—toward cultural acceptance, the health care system is in a better position to capitalize on telehealth’s original promise of expanded access, lower cost and better outcomes than it was two years ago. But in the wake of the pandemic, it is just as clear to us that if telehealth is to live up to its full potential, some changes are needed. The rest of this article presents five ideas for improving the delivery of telehealth going forward.