Description: This session includes a new idea based on dynamic treatment regime work (OWL) and integrating cost into this work. This will enable identifying the best treatment for a patient based on both outcomes and cost. This is novel for actuaries because in previous analysis we have used cost only in the after-analysis, whereas here we use it in the actual analysis and treatment identification. Moreover, this analysis provides a way to consider multiple treatments for a patient (including the no treatment option) and choosing among those multiple treatments, for both outcomes and cost. This session will share the background theory and set up a case study. The case study will parallel what is in the analysis in the book by Ian Duncan 'Predicting Hospital Readmission with Case Management Recommendation.' This analysis will then go further to compare a situation where there are multiple potential case managers. Also, this will potentially explore care pathways and choosing the best care pathway for a patient based on health outcomes and cost combined.

Description: Traditional Medicare [TM] has many coverage gaps and no out-of-pocket maximum. Most members must purchase a Medicare Supplement Plan and a Part D plan for pharmacy coverage. Over 50% of members have opted for a Medicare Advantage [MA] plan that replaces TM and the need to purchase a Supplement and (in most cases) a Part D plan. All this for less cost to the member, but at a greater overall cost to the federal government even though MA plans provide TM benefits for less than it costs the government. The attendee will learn why this occurs. However, given these facts, the focus of the session will be on the future of Medicare: namely, should the parameters regarding MA bids and payments be limited to what is paid for TM, or can we take the best administrative techniques of MA and TM to provide more robust benefits for all Medicare members at a cost no greater than the government is currently paying? Or is there an even better idea?

Description: What if a blood test can detect more than 50 types of cancer, including those in early stages? A biotech company, GRAIL, has developed the first-to-market Multi-Cancer Early Detection test and launched it for commercial use in 2021. Join us to learn how Munich Re and GRAIL are partnering to bring its Galleri test to the life insurance industry. You will also explore how we as an industry can help save lives by detecting cancer earlier and share perspectives on some early findings and cost-benefit analysis

Description: Join us for an insightful webcast as we delve into the far-reaching implications of the recent Supreme Court decision to overturn Chevron deference. This landmark ruling, which previously granted federal agencies significant leeway in interpreting ambiguous statutes, is set to reshape the landscape of healthcare policy.

Description: This article attempts to make a modest contribution to the dialogue on the potential and risks associated with novel treatments such as cell & gene therapies. With a fast-expanding roster of what are believed to be one-time treatments at ever increasing price points aimed at curing a wider swatch of the population, they are as much a source of relief for patients stuck in medical limbo, as they are a source of anxiety for payers.

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: Cost sharing reduction (CSR) payments are offered to low-income individual insurance buyers under the ACA. After October 2017, the difference in costs between the standard silver plan and CSR variants were defunded. To cover the costs of defunding, insurers have increased rates either through "broad loading" or "silver loading." States are approaching this adjustment differently, which is leading to some interesting differences between states. This article will review these differences.

Description: The article summarizes the results of the 2024 Life Reinsurance Survey of Individual Life and Group Life business written in the traditional life reinsurance markets of the United States and Canada. The article summarizes the new business volume written in 2024 and 2023 as well as the volume of ceded reinsurance in force at year-end 2024 and 2023.

Description: It is with great pleasure that we announce the winner of the “2024 Best Article” in Reinsurance News. Amongst a pool of exceptional articles, the article “What Does the Future of Mortality Look Like?” submitted by Adam Jedynak and Connie Cheng was chosen by the jury as the victorious submission. The article appeared in the June 2024 issue of Reinsurance News. It explores recent shifts in mortality, including post-COVID excess mortality, and looks at the impact of medical advancements and societal changes on mortality.

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.