Description: Health care continues to move from a fee-for-service model to a value-based care model. Hear from our expert panel how actuaries can play key roles in designing and contracting value-based agreements, monitoring experience, and driving results, as well as measuring value. The discussion will cover different structures currently in use, types of services covered (total cost of care, claim service lines, specialties, condition based, pharmacy products, etc.) and nuances by market (Medicare FFS, Medicare Advantage, Commercial, Medicaid). Listen to presenters discuss latest innovations in the value-based care space, as well as how current events have impacted these contracts. In this interactive session you will also be able to ask our diverse panelists questions.

Description: The Affordable Care Act (ACA) changed the health insurance value proposition for lower-income Americans. Consequently, the uninsured rate has dropped dramatically since the implementation of ACA marketplaces and the expansion of state Medicaid programs to a broader eligibility group. It is not difficult to connect the change in financial dynamics to the increase in health insurance coverage. At the same time, many Americans remain uninsured due to non-financial barriers. Identifying solutions to further reduce the uninsured rate is more difficult than intuitively 'spending more federal money'.

Description: You will be reminded how to spot and avoid statistical biases and fallacies that are common to health care actuarial data and problems. We plan to explain various statistical biases and fallacies and for each show one or two examples of how they might pop up in healthcare data and what strategies can be used to avoid/account for them. Likely topics include simpson's paradox, regression to the mean, base rate fallacy, sampling bias, survivor bias, Berkson's fallacy, and others.

Description: This article is an update on the No Surprises Act, which is a U.S. Act aimed to reduce the risk that a person unexpectedly receives out of network charges for their health care visits.

Description: Two years ago, before COVID-19 changed everything about how we provide and receive health care, telehealth was largely provided by third-party vendors to treat a narrow range of acute one-and-done conditions. The value proposition was simple: a fast and easy member experience would drive satisfaction and engagement; high member satisfaction and engagement would drive health plan savings and member retention. Clearly, from the perspective of utilization, telehealth—as a viable alternative to in-person care during a pandemic—worked. And with COVID-19’s nudge—or was that a push?—toward cultural acceptance, the health care system is in a better position to capitalize on telehealth’s original promise of expanded access, lower cost and better outcomes than it was two years ago. But in the wake of the pandemic, it is just as clear to us that if telehealth is to live up to its full potential, some changes are needed. The rest of this article presents five ideas for improving the delivery of telehealth going forward.

Description: Feature article featuring expert opinions on the future of health care

Description: Comparison of domestic and international PFML programs

Description: Derek Ray shares his excitement on serving as Chair of the Health Section Council in 2024, including recent section achievements, upcoming activities and a call to action for volunteers to contribute their expertise to the SOA.

Description: LIMRA and the SOA Research Institute have completed the most up-to-date study of term/whole life lapse/surrender. Twenty-eight companies contributed data to this Study, covering the seven-year period from policy anniversary in 2015 to policy anniversary in 2022.