Description: Joe Wurzburger, Staff Fellow at the SOA, shares some of his views and insights about the health care industry in general and the Health Section's role in particular.

Description: Joe Wurzburger, Staff Fellow at the SOA, shares his views and insights about the health care industry in general and the Health Section's role in particular.

Description: The big event of 2023 is the launch of multiple Humira biosimilars, which began in January with the arrival of Amgen’s Amjevita on the market. The launch of Amjevita kicks off the process of changing the specialty drug marketplace in the United States. The expectation of the full impact of this big event is very hopeful, but there is still uncertainty several months after its beginning. Humira is the highest-selling drug in the world and has been since 2013 (Figure 1)—except for when COVID-19 projects temporarily surpassed it. The world is eagerly awaiting the launch of multiple biosimilar drugs to compete with Humira and hopefully bring more competitive pricing to the benefit of payers and patients everywhere.

Description: Joe Wurzburger, Staff Fellow at the SOA, shares his views and insights about the health care industry in general and the Health Section's role in particular.

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: Risk adjustment is used to adjust the revenue stream to health insurers that sell ACA eligible plans and Medicare Advantage plans. This article compares and contrasts these risk adjustment programs.

Description: Joe Wurzburger, Staff Fellow at the SOA, shares his views and insights about the health care industry in general and the Health Section's role in particular.

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: This article discusses a multiyear design for stop-loss reinsurance used by employers offering self-funded medical benefit programs.