Description: Similar to how states had made adjustments to their capitation rates to reflect acuity adjustments caused by the onset of the pandemic, states will need to modify the rates to reflect the unwinding since utilization patterns and average acuity per enrolled member will change. When the continuous coverage requirements set forth by the COVID-19 Public Health Emergency (PHE) ended, Medicaid-managed care programs across the country adopted various approaches to phasing out maintenance of effort (MOE) as a result of changes to the PHE-era continuous eligibility requirements. Phasing out the MOE requirement will ultimately result in members who no longer meet eligibility requirements losing their Medicaid coverage. Further, states are facing a wide variety of circumstances and are implementing diverse approaches to the MOE phase-out. This topic will be of significant interest to all actuaries and stakeholders of the capitation rate development process for Medicaid-managed care programs. Join us as we discuss the operationalization of the PHE unwind while referencing the SOA's research project which models the effects of the unwinding on Medicaid eligibility and population costs. You will learn about the various approaches that different states have adopted to manage the unwinding process, which will be instrumental for accurately pricing managed care rates.

Description: Dive into a summary focused on the discussion from the Health Section's Pharmacy Partnership Forum in March 2023 entitled 'Reimagining Pharmacy Financing' where a multi-disciplinary group of clinicians, health economists, academics, and actuaries met and discussed the following questions: - How do we define the value of prescription drugs? - How do we measure the value of prescription drugs? - How do we scalably and meaningfully apply the answers?

Description: Research Objective The Society of Actuaries Research Institute General Insurance Research Committee is seeking researchers to identify and analyze the various by-component inflationary forces on pet insurance affordability in the United States and Canada. In addition, we seek ideation of potential solutions that are likely to improve the affordability of pet insurance.

Description: This article explores the disruptive applications of blockchain, an emerging technology, and its impact on the pharmacy benefit space, and pharmacy benefit managers (PBM).

Description: Can Direct-to-Provider Contracting Achieve Value-Based Care for Employer-Sponsored Plans? Direct-to-provider contracting is a strategy in which a self-insured entity negotiates a contract directly with a provider of healthcare services rather than through a third-party administrator (TPA), often with the goal of driving value-based care. This article discusses the considerations for employers and providers with direct-to-provider contracting.

Description: This excerpt is from a presentation done by a panelist at the Intercompany Long-Term Care Insurance Conference Association closing session in Chicago in March. We can never fully express our thanks to the Alzheimer’s Association and Tom Doyle for the courage to share his moving story and optimism for the future.

Description: Article discusses causes of high charges in relations to reimbursement arrangements and possible actions of insurers & payers. Issue No. 45.

Description: Q&A with President Life & Health US. Swiss Re. Neil Sprackling.

Description: Papers: Does Living in a Retirement Village Extend Life Expectancy? The case of Whiteley Village in the UK. – Les Mayhew, Ben Rickayzen and David Smith, Ph.D. – City University, London Health and Social Care Analysis Regarding the State of Canadian Women Living in the Alone Stage of Retirement – Douglas Andrews, FSA, FCIA, Ph.D.; Lori Curtis, Ph.D. – University of Waterloo

Description: This tool created graphs of Google's mobility Data. This version of the tool contains global, country-level data through July 31, 2020