Description: Presents a step-by-step methodology for calculating confidence intervals for IBNR estimates derived using the Averaqe PMPM method. It is a companion article to the January 2023 Health Watch article presenting the Average PMPM method for generating point estimates of IBNR with zero claims runout.

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: "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: "Risk adjustment (RA) is a key component for CMS Medicare Advantage program and California Medicaid Managed Care program. While both RA programs follow generally accepted basic principles at a high level, their underlying methodologies and assumptions are also quite different. Due to recent events such as COVID-19 Public Health Emergency and Medicaid redetermination delay and restart, it adds complexity to Risk Adjustment. This is a hot topic in the industry and has significant impact to health plans. Keeping current with risk adjustment program changes and understanding the commonalities and differences of these two government risk adjustment programs is important to our health actuaries. Compare these two risk adjustment programs so you can learn key elements of a risk adjustment program, similarities and differences in methodology and assumptions , as well as special considerations due to serving different populations."

Description: "Court is in session and you are the jury! Follow along as challenging aspects of actuarial professionalism are explored in a court-like setting. Deliberate among your peers based on what you already know from your own experience as well as what you learn in this session, and then deliver your verdict accordingly. If you attended in the past, plan on joining again as we will have new material and updates for discussion. Who says learning about actuarial professionalism can't be fun? By attending the session, you will be able to: Apply actuarial professionalism concepts Identify key ASOPs for actuaries Explain significant aspects of the U.S. Qualification Standards"

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

Description: This report illustrates employer group commercial health care costs and trends from 2013 – 2017.

Description: The Society of Actuaries (“SOA”) Research Institute is the research arm of the SOA, providing objective, data-driven research that brings together tried and true practices and future-focused approaches to address societal challenges and business needs. The Institute provides trusted knowledge, extensive experience and new technologies to help effectively identify, predict and manage risks.

Description: Plan Sponsor Perspective