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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 is Part 2 of 2 on changes affecting Medigap insurers. It focuses on marketing and regulatory differences between Medigap and Medicare Advantage that affect the competitiveness of Medigap plans.

Description: 2014 marked a new beginning for small group(SG) health insurance market ushered in with adjusted community rated products priced from a single risk pool. It was anticipated that the mandated pooling of the risk would result in higher rates, especially for healthier groups. It is the aim of this article to show whether that view bears out in the actual market rates and if it is higher, then by how much. The article provides a point in time(1st quarter 2025) comparison of premium rates under two segments of the small group market, namely Qualified Health Plans(QHP) available under the small group ACA market versus self-insured Multiple Employer Welfare Arrangements(MEWA) plans.

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: The Society of Actuaries (“SOA”) Research Institute is the research arm of the SOA, providing objective, data-driven research that brings together tried and true practices and future-focused approaches to address societal challenges and business needs. The Institute provides trusted knowledge, extensive experience and new technologies to help effectively identify, predict and manage risks.

Description: Pharmacy prices are top of mind for many consumers, policymakers, and payers. While there have been many efforts to reduce pharmacy costs over the years, many believe these efforts only helped us cope with the symptoms of the problem without providing a comprehensive cure for the underlying causes of this problem. The Society of Actuaries Health Section sponsored this Pharmacy Partnership Forum to gather multi-disciplinary experts in the pharmacy ecosystem. This report shares the insights and learnings that emerged from this group of health economics outcomes researchers, clinical pharmacists, medical doctors, health actuaries, benefits consultants and brokers, and their collective thoughts on advancing this exploration for society’s benefit.

Description: This report is presented in the form of a Tableau dashboard and is the sixth public release from this report series and contains the results of an excess mortality analysis for the fourth quarter of 2021. Data from 30 companies representing approximately 69% of the industry’s face amount inforce were included in the analyses in this report. A total of 3.2 million death claims from individual life policies from 2015 through December 31, 2021 make up the basis of the analyses. The report also compares the experience under COVID-19 of the insured population versus the general population.

Description: LIMRA, Reinsurance Group of America (RGA), the Society of Actuaries (SOA) Research Institute, and TAI have collaborated on an ongoing effort to analyze the impact of COVID-19 on the individual life insurance industry’s mortality experience and share the emerging results with the insurance industry and the public. This report documents a high-level analysis of the claims that have been reported.

Description: This report is a comprehensive survey of existing literature on mortality and race and ethnicity in the United States, examining disparities in mortality rates among different racial and ethnic groups. It explores factors influencing mortality differentials, including socioeconomic status, health care access, and other relevant aspects.