Description: The Society of Actuaries (SOA) commissioned Milliman to develop this report to provide health care stakeholders—patients, payers, policymakers and actuaries—with a comprehensive description of DPC as well as an objective actuarial evaluation of certain claims made about the DPC model of care.

Description: The presenters will provide updates on research being conducted under SOA sponsorship. This includes projects on the topics of Direct Primary Care and Patient Centered Medical Homes.

Description: Can Direct-to-Provider Contracting Achieve Value-Based Care for Employer-Sponsored Plans? Direct-to-provider contracting is a strategy in which a self-insured entity negotiates a contract directly with a provider of healthcare services rather than through a third-party administrator (TPA), often with the goal of driving value-based care. This article discusses the considerations for employers and providers with direct-to-provider contracting.

Description: As value-based solutions evolve, it is more important than ever for providers to understand their performance and how it is measured, along with the drivers of success. Presenters will cover the evolution of past risk-transfer programs such as Medicare Shared Savings Program and Next Generation ACO. They will also discuss the new Primary Care First and Direct Contracting models recently announced by CMS.

Description: Actuaries have the business acumen, problem-solving capabilities, and technical skills to develop innovative and data-driven solutions in the social insurance space. It is time we expand our scope and embrace an increased role in making a positive impact within the health care ecosystem. The primary focus of this paper is on social insurance programs dedicated to the most vulnerable population: low-income families accessing care through Medicaid. While there are numerous challenges that require other subject matter experts to take the lead, this article highlights topics where actuaries can be key players in developing and implementing tangible solutions to improve the care for the most vulnerable. Issues and solutions in this paper focus on the following three areas: 1. Access to appropriate care, 2. continuity of care, and 3. social determinants of health.

Description: It’s well documented that oral health is correlated with overall health. An exciting array of new dental technologies is emerging, from virtual reality through AI to CRISPR. These ground-breaking advancements have the potential to revolutionize dentistry.

Description: Telehealth came to the forefront in a significant way during – 2020–2021, partially due to the pandemic. What is the reasonable expectation of future consumer use of telehealth? This virtual option has the ongoing potential to increase access to health care services to plausibly lower the cost of care. Furthermore, telehealth continues to evolve as a technology. Keeping current with advancements as well as consumer willingness to use this medium are important to the future of health insurance. By attending this session, you will learn about the latest advancements in telehealth as well as implications for cost of care due to consumer use.

Description: This paper helps the audience understand the actuary’s role in estimating the financial impact of primary care programs. In addition, the paper can be used by actuaries to think about key issues when estimating the financial impact of their employers’ and clients’ own primary care programs.

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: This article describes some of the traditional profit measurement standards for direct marketing and then presents a more comprehensive and up-to-date foundation for insurance direct marketers and actuaries to use when reviewing individual direct marketing campaigns or total marketing programs.