Description: These past two years have been the most challenging of my professional career, and I’m certainly not unique in this regard. Fortunately, I’ve benefited from a little help from my friends in the actuarial community—no one sticks together like actuaries.

Description: Article discussing how the pursuit of value-based care as a consequence of health care reform laws such as the Affordable Care Act (ACA) and the Medicare Modernization Act has accelerated the use of risk adjustment and what it means to actuaries.

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: 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: This article is a concise guide to assist health actuaries with CPD attestation. It describes the requirements of United States Qualification Standards and the SOA Basic Requirement provisions of Section B. It also describes when each set of standards are appropriate.

Description: On July 19, 2021, the Health Section and the Reinsurance Section of the Society of Actuaries (SOA) cohosted a webinar titled “Modeling the Financial Effects of Emerging Cancer Treatments,” which provided an overview of rapidly evolving cancer therapies, including cell therapies (CAR Ts), gene therapies and specialty drugs.

Description: 2021 SOA Health Meeting Recap

Description: Social determinants of health (SDoH) have been a topic of growing interest in recent years, yet consensus about what the phrase represents and how health-related social needs should be studied or addressed by employers, health plans, providers and other stakeholders in the business of health care have been lacking. For many, low-income populations come to mind when considering the topic, yet SDoH include a wide range of factors beyond income. Many types of data are available, yet each presents distinct challenges and opportunities for analysis. In this article, we describe some of the underlying context for considering SDoH, as well as some of the potential data sources to consult and challenges to grapple with on this important topic.

Description: Introduction to additional actuarial research into development of and regulatory impact, economic impact and consumer impact of prescription drugs in the United States. Intended to further educate actuaries and others who work in this area and motivate more actuarial involvement to increase transparency, increase competition, better align stakeholder incentives and better mitigate total cost of care increases