Description: State Medicaid agencies have been implementing value-based payment (VBP) models for the last decade and are increasingly exploring advanced population-based payment (PBP) models that increase flexibility, predictability, and accountability for participating provider organizations. PBP models show promise in advancing Medicaid priorities, but are still in the early stages of development, and model design and implementation challenges remain. This article from the Center for Health Care Strategies explores the fundamentals of VBP and how PBP - a particular type of payment model - can help Medicaid agencies achieve goals related to care transformation and quality improvement, revenue stability, and controlling cost of care.

Description: This article attempts to make a modest contribution to the dialogue on the potential and risks associated with novel treatments such as cell & gene therapies. With a fast-expanding roster of what are believed to be one-time treatments at ever increasing price points aimed at curing a wider swatch of the population, they are as much a source of relief for patients stuck in medical limbo, as they are a source of anxiety for payers.

Description: Actuarial Perspectives on COVID-19: June 10 Twitter Chat with the Society of Actuaries

Description: In late 2021, U.S. Congress passed the Consolidated Appropriations Act (CCA), which requires group health plans and health insurers to submit information regarding the costs of prescription drug costs and other health care services each year to the federal government. Learn how this data can be useful to anyone responsible for forecasting and budgeting.

Description: "Direct medical costs for cancer care topped $209 billion nationally in 2020, accounting for a significant proportion of all health care expenditures in the U.S. Indirect costs are also significant, encompassing loss of productivity, wages, leisure time and decreased quality of life. The way cancer programs deliver and are reimbursed for care is rapidly changing. As the cost of cancer care continues to rise, several new value-based care programs - both public and private - have attempted to curb these rising costs. Learn about the current landscape of VBC oncology programs, several key challenges and opportunities with oncology analytics, as well as anticipated evolution of cancer care in the near future. Topics include: Current VBC oncology landscape, including a more detailed discussion on CMS' latest oncology program, Enhancing Oncology Model (EOM) Discussion on current challenges and opportunities with oncology analytics, including some advanced methodologies that have been developed based on documented clinical pathways to better understand cost drivers Future state of oncology care including emerging pharmaceuticals and novel therapies, personalized care regimens, and other clinical innovations"

Description: This report explores the financial planning, support networks, health concerns, and use of technology among older adults who identify as solo-agers.

Description: In today's growing supplemental health space, innovative benefit offerings are essential for both marketability and market competition. Discuss the latest trends in accident, critical illness, and hospital indemnity plan design, as well as the regulatory hurdles that can be involved when implementing these new benefits.

Description: CMS launched the value-based insurance design (VBID) model in 2017, allowing health plans to offer innovative supplemental benefits and incentives to beneficiaries to use high-value services specific to their health care needs or socioeconomic position. CMS's stated goal is to encourage health plans to implement strategies that focus on health equity. The model has evolved over time and has grown tremendously in popularity over the years since it was introduced.

Description: This report provides actuaries and other professionals working with risk, data and analytics or program evaluation in the health care space with considerations and frameworks related to the use of determinants of health (DOH) in data and actuarial work streams. Such frameworks can leverage new data sources to enrich health care data analysis to move beyond traditional data elements, such as age, gender, zip code or health diagnosis.

Description: In recent years, Artificial Intelligence (AI) has taken an increasingly prominent role as a potential tool for improving processes from standard internet searches to its use in improving actuarial modeling through machine learning and other applications. The use of AI models and machine learning could lead additional and ongoing improvement of predictive capabilities in health care reserves resulting in potentially more accurate reserve estimates, financial statements and decreases in model variance.