Description: Hear an overview of recent results and potential scenarios that may impact the future of the ACA market. Review recent reported industry level profitability before transitioning to a discussion of how current market dynamics may influence the future profitability of this segment. Results from microsimulation economic models will be presented to help illuminate market shifts. Issues that will be explored include how ICRA availability might influence individual decision making, as well as how a move to level funding is impacting the small group market.

Description: Explore the findings from the research paper recently released by Milliman and the SOA, highlighting the growing need for support of informal/family caregivers. We will discuss both quantitative and qualitative data that illustrates not only the cost and burgeoning need, but the mental/emotional stressors that come along with this work.

Description: In this session, we will review how the previous and current concerns of pharmacy actuaries will affect the forecasting and review of upcoming pipeline events. After this session, attendees will have a broader understanding of the implications of what is coming next in the pharmacy pipeline and how they can be thinking about it.

Description: As health insurance self-funding becomes more popular among smaller group sizes, risk is evolving for the MGUs, stop loss writers, and reinsurers that cover them. Assessing more small groups at lower attachment points means rethinking traditional stop loss underwriting techniques.

Description: This session reviews the importance of using benchmarks in healthcare utilization management to improve organizational and patient outcomes and increase efficiency. It highlights how benchmarks can inform decisions about utilization management strategies and benefit members, payers, and providers. The presentation includes best practices, successful examples, and solutions to challenges, focusing on claim utilization, risk adjustment efficiency, quality metrics, and overall performance. Additionally, insights into the future of benchmarks and the value of analyzing the entire distribution of data for deeper insights will be shared.

Description: Overview of call center and digital sales platforms for the development of distribution strategy in the individual insurance market.

Description: What are Biosimilar drugs? Are they the same as generic drugs? What potential impact might Biosimilars have in the United States prescription drug landscape and it’s economics? This article explores those questions as well as exclusivity and interchangeability.

Description: When designing and pricing a healthcare product, it is not only important to know how to model frequency and severity, but it is essential to understand human behavior. Of course, the issue of anti-selection in medical insurance is well known as individuals know more about their health and prior expenditures than an insurer does. This type of behavior is certainly rational, and to be expected.

Description: Inspired by other financial savings products available to Canadians, this article describes a potential solution for financing future health expenses with the creation of a Registered Health Savings Account (RHSA). This solution has been thought on the basis of four premises : 1- Individual Accountability for Health Expenses; 2- Early Savings Leads to More Accumulation; 3-PreferredTax Treatment for Personal Health Savings; 4- Complementing current public and private health systems; Main elements of the RHSA are described (Contributions, Accumulation, Utilization of account, Management by financial institutions).RHSA'S expected balances and some other results under three scenarios (a person in good health, one in poor health, and one with unexpected death at age 45) are summarized in a table. Health expenses deducted yearly from RHSA's balance were estimated using total, per capita, provincial government health expenditures by age-band for Canada, in 2020, from the Canadian Institute of Heath Information’s (CIHI), which account for 71.8% of total expenditures, that is public + private. Thus 28.2% of total expenditures were used for private health expenditures, then forecasted to 2024 and projected using a 4% annual trend. Some objections to the solution explored were anticipated as well as some refutations to these objections.

Description: The Actuarial Research Clearing House (ARCH) is an informal communication providing current actuarial research to friends and members of the actuarial community. View the second issue for 2024.