Description: This report presents the results of a study comparing health risk scoring models.

Description: An interview with Jim Toole, lead researcher for SOA's pandemic research project. The project examines pandemic influenza and its implications to the life and health insurance industry.

Description: Appendixes for the Evaluating ACO Efficiency: Risk Adjustment within Episodes study. The study aims to answer the question of how much of an episode’s cost and use of specific services can be attributed to the patient’s own health status, as opposed to being driven by other factors such as the care setting, patient preference, and provider practice patterns. In other words, do episode costs vary so widely because of patient characteristics, including health status, or are they related to other, nonclinical factors?

Description: On March 6, 2023, The Wall Street Journal hosted its Health Forum, a hybrid all-day event. The virtual meeting featured 11 different events. This white paper focuses on those events. The sessions were informative and fast-paced, with each one providing a quick hit of relevant and cutting-edge information around health care.

Description: Changes introduced by various Medicare Alternative Payment Models and the Medicare Access and CHIP Reauthorization Act (MACRA) have accelerated an existing market trend of shifting some of what has traditionally been considered “insurance risk” to providers. The Provider Risk Sharing Boot Camp will give attendees deeper insights into methods, current thinking, and alternative solutions that actuaries can use to help providers understand and manage the financial and actuarial risks that they are taking, many for the first time.

Description: Fifty-three percent of Americans responding to a survey conducted by the Society of Actuaries (SOA) Research Institute reported that extreme weather events – including hurricanes, tornadoes, heatwaves, wildfires and flooding – have adversely affected their health.

Description: The proposed session will introduce Outcome Based Risk Sharing Arrangements (“OBRSA”) between health insurance payers (“payers”, including insurance companies, health plans, sponsored employers, and government programs) and pharmaceutical manufacturers (“pharma”), and it’s intended to meet the needs of actuaries who focus on pharmacy benefits and risk sharing arrangements. The covered content will include (1) the background of OBRSAs, definitions, stakeholders, and OBRSA’s role in shifting the system from volume-based toward value-based; (2) conflicting perspectives about OBRSAs between payers and pharma (cultural and methodological); (3) identification of incentive gaps between payers and pharma, and incentive alignment between them; (4) barriers to implement OBRSAs; (5) limitations and considerations of OBRSA implementation; and (5) hypothetic OBRSA examples.

Description: The value-based ERM approach is a robust yet practical synthesis of enterprise risk management and value-based management, and has been used to help a range of companies – financial services companies, non-financial services companies, and non-corporate entities alike – successfully implement their ERM programs and integrate ERM into their decision-making processes.

Description: For the top-20 key risks, the carriers were asked to identify the key risk indicators (KRIs) they use for monitoring and the activities they use, or plan to use, to mitigate the likelihood of occurrence and/or the severity of impact.

Description: The SOA Research Institute Catastrophe and Climate Strategic Research Program released a report that explores the shifting geography of Lyme Disease in the U.S. and beyond and some of the potential determinants of its spread. Lyme Disease is a well-known disease particularly in the eastern U.S., and it is also prevalent in other geographies. This report researches the complex relationship between climate variables and the spread of Lyme Disease in the United States.