Description: NAIC Health Update from quarterly meeting. Issue No. 42.

Description: Opioids overdoses have contributed to increases in mortality among white American. This article gives some detail on the speed and the reach of the epidemic.

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: This article outlines and summarizes research from Swiss Re about the prevalence of the Health Protection Gap throughout Asia, with a particular focus on China. Authors Robert Burr and David Zhang share key statistics on the scope of the gap, which is more than 800Bn USD in China alone, and discuss the role that technology and private-public partnership can play in reducing this gap over time. Readers will come away with an understanding of the scale of the problem within the Asia region as well as new ideas on how to solve similar problems within their own region.

Description: The coming wave of biosimilars could dramatically affect prescription drug costs and benefit strategies over the next several years. The launch of many Humira biosimilars in 2023 is the Big Event that will largely determine the impact of the biosimilar wave. Payers have many decisions to make about coverage and formulary tiers. What factors will drive payer decision-making?

Description: A discussion of outrageous, criminal and soft fraud in health insurance.

Description: A research report that first defines ERM and provides the results of an applicable literature search with hyperlinks and then describes the current state of Enterprise Risk Management practices for health organizations. Areas covered: 1. Operational Risks. 2. Balance sheet risks. 3. Pricing discipline. 4. Asset risks. 5. Learnings. 6. Emerging risks.

Description: A research report describing aspects of provider network performance in health care settings with particular focus on experiences with Exchanges.

Description: This article discusses the potential characteristics of health care reform and the associated impact on small insurance companies.

Description: Authors demonstrate the use of the claim reserve run-out test for the long-term A&H products. They present the method of this test and show a numerical illustration to depict interpretations of testing results.