Increase the Stability of the Health Insurance Market: Take the Actuarial Challenge
The results from Round One are in. Read the announcement here.
Webinar: Actuarial Challenge – Announcement of Round One Results
The Affordable Care Act (ACA) brought extensive changes to the individual health insurance market. Accolades as well as concerns have been raised by stakeholders as the market evolves under the new structure.
While access to health insurance coverage has increased significantly since the implementation of the ACA, costs also have continued to increase, provider choice has become increasingly restricted, and in some cases provider network adequacy and quality have come into question. A number of health plans have exited the exchanges, reducing consumer plan choice. Other health plans have incurred losses year over year.
These complications could threaten the improvements to access that have been achieved, which in turn could lead to further increasing costs. Many are questioning the sustainability of the system over the long run.
In light of these observations and developments, the Robert Wood Johnson Foundation (RWJF) has engaged Milliman to conduct a collaborative Actuarial Challenge to test different approaches to increasing stability in the individual health insurance market. The American Academy of Actuaries has joined with RWJF to promote the challenge among its members. The Actuarial Challenge is targeted to elicit innovative ideas and proposals from informed actuaries to move the individual insurance market further toward the goal of universal access to quality health services and providers in a financially secure and stable way with consideration of the costs the solution places upon individuals, employers, health care providers, taxpayers (present and future), and other health sector stakeholders.
The challenge seeks to bring together various health care actuarial experts associated with the various market stakeholders to address the above issues. The challenge will begin in September and conclude in April. The targeted challenge participants include, but are not necessarily limited to, actuaries employed by:
- Health insurance companies and health maintenance organizations (HMOs);
- Health care providers (health systems, hospitals, physician groups);
- Pharmaceutical companies and pharmacy benefit managers (PBMs);
- Actuarial professional organizations;
- Health actuarial consultants; and
- Colleges and universities with actuarial science programs.
The participants will work in collaborative teams. The teams will consider different policy levers to test alternative approaches for promoting increased enrollment, stable costs, and wide health plan participation in the individual health market. Each team will prepare a paper and a presentation of its proposed solution for an expert panel of judges, who will select proposals to move forward in the challenge based on their estimated impact, feasibility, and other criteria.
Each proposed solution will discuss how the suggested changes would affect the individual market as well as other health care system stakeholders. Each team’s work product will also address the effect of the proposed changes on consumer access to health care providers, including how quality of care and the supply of providers might be affected. A panel of judges will select five of the proposals to move forward to an analytic phase in which the market impact will be modeled and quantified through use of a single common simulation system operated by Milliman. This analysis will include a projection of market size (including the uninsured population), premium levels, total health expenditures, and cost-sharing among consumers, employers, providers, and taxpayers. The impact will be measured against a common baseline model reflecting the current market environment.
A successful conclusion to the challenge would result in realistic, innovative solutions, which further stimulate discussion about moving the individual health insurance market forward toward meeting the goals stated above. The results of the challenge will be publicly disseminated and shared with policymakers.