Description: The impact of Medicare payments on retiree medical. Issue No. 46.

Description: Applying Diagnosis-Based Predictive Models that use medical and pharmacy claims to measure expected costs for Group Underwriting. Issue No. 46.

Description: This research report is sponsored by The Society of Actuaries and the Canadian Institute of Actuaries on the Canadian health care system. Performed by Stéphane Levert, FSA, FCIA, the study (available in French and English) estimated the future costs of the Canadian health care system, assessed the sustainability of the system over a 25-year horizon, and analyzed the implications of the changes to the Canada Health Transfer proposed on Dec. 19, 2011 by the federal government. The report summarizing the findings indicates that, without significant government intervention, the Canadian health care system in its current form is not sustainable.

Description: Research report measuring the annual frequency of medical errors in the United States and the total measurable cost to the United States economy of these errors.

Description: Healthcare costs have been rising faster than general inflation for many years. Early models that predicted this past pattern projected healthcare expenditure growth that continued to outpace total expenditure growth leading to the fallacious position that the whole of the US economy would ultimately be consumed by healthcare. The Society of Actuaries' Pension Section and Health Section Research teams commissioned Professor Thomas E. Getzen of Temple University to construct a resource model for the projection of long term healthcare cost trends that includes capacity constraints to ensure the long-term projection is rational. The motivation for creation of the model was driven by its potential usage as a resource for the estimation of reportable liabilities for retiree healthcare benefits as specified under FAS 106 and GASB 45 accounting statements. This is a zip file containing the following: 1. A background paper on the creation of the health trend model, 2. The model, programmed in Microsoft Excel [xls format], that projects per-person expenditures and growth rates through 2099 using baseline assumptions, but also permits the flexibility for user–inputted alternative assumptions, and 3. Technical documentation providing transparency and support for the ultimate results.

Description: The document is a research call for proposals seeking researchers to produce a report on the uses of synthetic medical claims data for actuaries. It outlines the background, purpose, research objectives, proposal requirements, selection process, and conditions for submission.

Description: This study would assess the impact of recent patient care innovation(s) on health care and the health insurance industry.

Description: Adam Barnhart and Stephanie Moench, the co-charis of the new Health Community, announce the official community launch, which merges the former Long-Term Care and Health Section Councils into a single, unified group. The community aims to foster professional development through high-quality education, research, and collaborative networking for actuaries. To ensure a personalized experience within this large organization, members are encouraged to join one of more than 12 specialized subgroups. These groups offer focused discussions and expert insights via regular topic calls and private listservs. Under the new community model, members have flexible opportunities to contribute without needing to hold an elected position. Volunteers are sought for content creation (articles, podcasts, and webcasts), subgroup leadership, and industry research projects. Members can browse available subgroups and volunteer opportunities through the Society of Actuaries (SOA) website. By integrating these legacy sections, the Health Community strives to build a vibrant, innovative future for its members at every career stage.

Description: There are many ways to actively utilize BE approaches – and implementing these important tools can help insurers in many ways.

Description: PBMs are positioned in the healthcare delivery system as the only entity that is not regulated for profitability. The Commercial Fully Insured Health Insurance Plans are heavily regulated by the State Insurance Commissioner who allows only 2%-3% profit margin. The self-funded Health Plans are regulated by ERISA fiduciary responsibility that prohibits excessive compensation. PBMs are classed as a service provider and are not regulated by either. This allows PBMs to implement large, unreasonable mark ups for profit. PBMs are massive commercial entities, states are trying to sue under antitrust law. PBMs found a sweet spot in the regulation. Large Insurance Carries understood that and either acquired large PBMs or merged with them. It is likely that a combination of measures will be needed to regulate PBMs. The most direct approach would be for Congress to pass a law establishing PBM as a fiduciary under ERISA just like an “investment advisor” providing advice for a fee. Establishing PBM as a fiduciary will help Courts and other Federal Agencies ensure that PBMs do not unfairly retain rebates and inflate the prices of Rx drugs sold to employer health plans, and the US population in general.