How do we solve the problem of out-of-control healthcare costs? A group of actuaries is giving it their best shot

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The Society of Actuaries and Kaiser Family Foundation are taking aim at rising healthcare costs. (Getty/NicoElNino)

Plenty of groups have banded together in hopes to bend the healthcare costs curve.

But a new pairing of experts decided to take a crack at it—and they're bringing some pretty specialized expertise to the problem.

The Society of Actuaries and Kaiser Family Foundation formally launched the new effort officially dubbed “Initiative 18|11” this week. (In case you're wondering, they named it that since healthcare accounts for 18% of gross domestic product in the U.S., and is 11% in other countries, such as the United Kingdom.)

Conference

13th Partnering with ACOS & IDNS Summit

This two-day summit taking place on June 10–11, 2019, offers a unique opportunity to have invaluable face-to-face time with key executives from various ACOs and IDNs from the entire nation – totaling over 3.5 million patients served in 2018. Exclusively at this summit, attendees are provided with inside information and data from case studies on how to structure an ACO/IDN pitch, allowing them to gain the tools to position their organization as a “strategic partner” to ACOs and IDNs, rather than a merely a “vendor.”

Brian Pauley, a fellow with the Society of Actuaries and the initiative’s chair, told FierceHealthcare that with the amount of talk on healthcare costs, it was an issue that actuaries could clearly play a role in solving.

“The directive was, ‘How can we better position actuaries in the cost of healthcare conversation?’” Pauley said.

The two groups, with help from the Healthcare Financial Management Association, pulled together some of their top experts across the industry in March 2018 to develop their central goals, including:

  1. Conducting in-depth research on the costliest patients, or the 5% that account for 50% of healthcare costs. (They've dubbed that the 5/50 Research Project.)
     
  2. Developing a project aimed at providing greater clarity into the drug pricing process—from the nexus of new product to the time a patient visits the pharmacy counter.
     
  3. Doing a deep dive into how new tech and care models are impacting cost and quality, as the industry drives toward “Managed Care 3.0.”

RELATED: Study identifies persistently high-cost Medicare patient trends

Larry Levitt, senior vice president for health reform at the Kaiser Family Foundation, said the partnership combined the foundation’s industry know-how with the actuaries’ “analytical firepower.”

“No one realistically believes that the U.S., in our lifetimes, could get down to what other countries are spending,” he said, “but the widening gap should command attention.”

Overall, both said they hope the ongoing project brings some clarity and light to one of the industry’s most complex—and pressing—issues. “There’s a consensus that the price of healthcare is too high. There’s hardly a consensus around what do about it,” Levitt said.

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