Axene Health Partners, LLC

One of the significant changes we have observed since the pandemic began is in the portion of companies that are choosing to self-fund their benefits. According to the Kaiser Family Foundation 2020 Employer Health Benefit Survey, 67% of covered workers are in a self-funded plan. That means that nearly 2 out of 3 covered workers are covered by a plan that is not directly insured by an insurance company, but rather work for a company that is taking on the risk of their own health benefits. Read the full article to learn more. https://bit.ly/3zIdsyg

The most frequently asked question about self-funding that we get is how big should our group be in order to consider self-funding? The answer to that question is not as easy as it might seem. There is no magic number that makes it work. Groups of all sizes can thrive being self-funded, it just depends on the risk appetite of the company. https://bit.ly/2DSxMV5

Josh Axene authored The Real Cost of Vaccinations, a 2019 article looking at the effects of vaccine misinformation in Samoa. In the article he gave us a prescient glimpse of what we now face in the United States. "Healthcare today is full of misinformation; people often believe what they want to believe and ignore facts. Many people will accept what a celebrity might say and not what their own doctor advises them to do. As an actuary, I look at numbers and try to quantify ris...k. There is no number I can find that says avoiding vaccinations lowers the risk of death. There is no medical support that says not vaccinating will raise the health of the general population. Misconstrued stories of deaths related to vaccinations caused a movement where people stopped vaccinating their children. The economy will be drastically affected and could take years or longer to recover financially. This does not even account for the emotional pain that families are going through over the loss of family members. As a society, we need to help prevent issues before they become a reality, and one way to do that is to properly vaccinate." https://bit.ly/3pKkfme See more

Medicare Direct Contracting: The Global and Professional Direct Contracting Model aims to transform risk-sharing arrangements in Medicare FFS and encourage providers to participate in CMS Innovation Center models. The incentive structure accommodates providers with varying risk appetites and reduces the administrative burden that might impede smaller groups from participating in similar arrangements. Over the course of the program, the benchmark expenditures used to calculate risk sharing targets are weighted more towards regional expenditures and less on DCE historical expenditures. https://bit.ly/3vs59od

The best way forward with AI is not to look at it as a threat to actuarial jobs, but to look at it as our newest coworker and assistant. As computers get faster and faster, they are able to look at more and more data and relate it to each observation. AI has the ability to connect data points from big data sets that may not have been connected in the past and or were too computationally complex to even consider in the past. When considering AI as a coworker or an assistant, actuaries can leverage and incorporate the output or results of AI into what we do and push actuarial science to new and exciting places. https://bit.ly/2TkNzT5

Is it possible a large one-time rate increase might be preferable to a series of smaller increases on LTCi premium rates? Read the full article to learn about a potentially counter-intuitive idea. https://bit.ly/2ZrnEfJ

Is poor supply/demand balancing causing the cost problem with our healthcare system? Read more about Healthcare resource planning: https://bit.ly/37oclHp

Axene Health Partners and Kaufman Strategic Advisors have released Payor Intelligence and Insights Cloud Application A strategic data tool developed to help healthcare-focused organizations better understand marketwide financial data. Learn more about this powerful tool: https://bit.ly/39zEuwG

Premiums for silver plans are too low in most states, and premiums for bronze and gold plans are generally too high. We find that this misalignment is consequential. If 2020 premiums matched coverage generosity as required by the ACA’s pricing rules, individual market coverage would have been substantially more affordable for the vast majority of affected consumers. Read more here: https://bit.ly/3sxhm8J

Don’t miss #CCA's; April 28th #healthcare #webinar = Professionalism for Healthcare Actuaries | U.S. Healthcare Policy What is a Healthcare Actuary’s Professional Responsibility? Governmental policies covering both public programs (e.g., Social Security, Medicare) and private arrangements (licensing, insurance regulation, etc.) have the power to make or break the long-term financial viability of the arrangements they are providing or regulating. Measuring the impact of th...ese policies, and projecting their future influence, are activities familiar to actuaries but complex and arcane to many public officials (both elected and appointed), not to mention to the general public. Speakers Stuart Alden of Socratic Methods, Frederick Kilbourne of The Kilbourne Company, and David Axene of Axene Health Partners, LLC will discuss their views on #actuaries’ professional responsibility to contribute to the formation and implementation of public policy, specifically in the healthcare arena. Visit https://bit.ly/3tIgW0R to register today! #OnlineLearning #DistanceLearning #ContinuingEducation #Professionalism #PublicPolicy #HealthcareActuaries

Don’t miss #CCA's; April 28th #healthcare #webinar = Professionalism for Healthcare Actuaries | U.S. Healthcare Policy What is a Healthcare Actuary’s Professional Responsibility? Governmental policies covering both public programs (e.g., Social Security, Medicare) and private arrangements (licensing, insurance regulation, etc.) have the power to make or break the long-term financial viability of the arrangements they are providing or regulating. Measuring the impact of th...ese policies, and projecting their future influence, are activities familiar to actuaries but complex and arcane to many public officials (both elected and appointed), not to mention to the general public. Speakers Stuart Alden of Socratic Methods, Frederick Kilbourne of The Kilbourne Company, and David Axene of Axene Health Partners, LLC will discuss their views on #actuaries’ professional responsibility to contribute to the formation and implementation of public policy, specifically in the healthcare arena. Visit https://bit.ly/3tIgW0R to register today! #OnlineLearning #DistanceLearning #ContinuingEducation #Professionalism #PublicPolicy #HealthcareActuaries

Congratulations to AHP Consulting Actuary Joan Barrett, FSA, MAAA on being recognized with a 2020 SOA Lifetime Volunteer Award. https://bit.ly/2I8BbSq

There has a lot of noise and not much substance in state responses to recent ACA regulations. We could argue that ACA dynamics are simply unintended consequences of the misunderstood policy. https://bit.ly/38UfChH

Much of the media coverage surrounding the COVID-induced economic situation typically pertains to the historic unemployment numbers, number of business closures, and the potential need for additional government stimulus to sustain the economy through this trying season. We all yearn for a return to our full economic potential after making sacrifices for the sake of flattening the curve. However, with that objective largely achieved the goalposts have shifted and our hopes to reignite our latent economy now rest in the timely delivery of an effective vaccine. Read more from Ryan Bilton's latest Inspire article: https://bit.ly/32azme2

AHP Consulting Actuary Greg Fann's notes some of the changing coverage goals of the ACA. The law primarily provided income-based financial incentives for insurance coverage and left operational aspects alone. And despite the name, the ACA has had little impact on the delivery of health care. In fact, the ACA did not significantly alter health insurance benefits; its real impact was premium changes unrelated to benefit changes. Read more: https://bit.ly/2G4bwcA

March marked the ACA’s 10th anniversary. The 2010 legislation has dominated the health care discussion over the past decade. Unlike any experiment attempted before, it sought to comingle a government program with a traditional private market and negate its actuarial design challenges with promotional efforts. Through a series of bumps and bruises, the ACA has weathered storms and has received boosts from legal rulings and new regulatory guidance. Read more Impressions of the ACA: https://bit.ly/3f88Ve6

With new COVID-19 hotspots emerging all over the country, it's critical now more than ever to prioritize determining the demand for healthcare resources. The AHP CPR Model uses actuarial principles to project COVID-19 cases and related resources required to treat patients with the Coronavirus. Learn more https://bit.ly/2Ka3VI0