Description: In this, the second step, Sibson engaged the vendor and actuarial communities to solicit input on the actuarial model for determining the impact of various environmental, lifestyle and behavioral risk factors. The goal was to understand the extent to which actuaries currently use models around wellness, refine the above conceptual model, and better understand the potential uses of, and value to, the actuarial and vendor communities that would use such a model. We sought to understand the potential applications and sources of data for the actuarial model. We gathered input on how the model would best suit the professional needs and help shape the future role of the actuary. Lastly, we gathered feedback on the above conceptual model.

Description: Article reviews the data a year into the unwinding of continuous coverage provisions in Medicaid, the impact on enrollment counts, how capitation rates have been adjusted, and compares those results to what has been modeled with the SOA Mediciad Unwinding model.

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: Using the Health Care Cost Institute (HCCI) database, we examined which characteristics best predict and describe high-cost members.

Description: The presenters will explore the roles of mental health and social determinants of health in the management of a population's total health. We will explore how emerging sources of data and information have led to a renewed focus on managing mental health conditions and social determinants of health. Speakers will address current health care programs that utilize this data and information to manage the total care for populations using predictive models to improve the deployment of resources and initiatives to improve the cost of care and health of populations. The presenters will also look at how providers of care are approaching mental health co-morbidities to manage physical health and social determinants of health in the management of patients.

Description: The winner's curse, applied to Affordable Care Act plan pricing.

Description: This article will consider several issues arising from ACO budgeting and pricing of stoploss coverage, including: 1) attribution of members; 2) claim carve outs; 3) ambiguous stoploss terms; 4) providers gaming the system and 5) credibility of data.

Description: This article begins with a comparison of the commercial risk adjuster to the exisiting Medicare model, and goes on to discuss why the existing strategies employed by health plans will not work in a risk adjusted environment. The article elaborates on the importance of diagnosis coding, controlling member mix, and care management in order to mitigate risks and gain from newly created opportunities.

Description: Summary of research from the Initiative 18/11 - Pharmacy team about the drug development process for traditional pharmaceuticals: Who does the research and discovery? What does the research and discovery process entail? How are targets identified and validated for research and discovery? What are clinical trials and how are they conducted? How is the drug development process regulated? How is the drug development process funded?

Description: Any analysis of risk assessment and risk adjustment must pay special attention to large claims. If the goal of risk adjustment is to motivate carriers to be efficient,, as opposed to motivating carriers to select the best risks,then finding a solution to the problem of compensating carriers fairly for these high-cost claimants is an absolute necessity. From A Comparative Analysis of Methods of Health Risk Assessment, M-HB96-1.ese