Description: Traditional risk scoring models include only fixed (non-random) demographic and condition-based variables. By including the provider effect as part of the risk scoring model as a random effect, we can get better estimates of provider performance (incorporating practice patterns conditional on patient morbidity profile). This approach can be generalized to study other factors that are now masked in error variance (i.e. area, Social Determinants) but if modeled could give us better estimates of risk

Description: A look at the near future and far future of various elements of Actuarial Models as defined through ASOP 51. What is driving the complexity for inputs, calculations, and outputs. Howe will actuaries handle these challenge?

Description: Actuarial concepts of credibility can be extended to encompass additional information provided by new machine learning estimates. New statistical ideas also indicate how to generalize to blend arbitrarily many estimators, while not double-counting common information. For example, historical claim costs and risk scores both leverage diagnosis code information. We introduce two new estimators, one based on partial correlation and the other based on the machine learning-derived Shapley statistic, to address these limitations.

Description: Article describing content and key takeaways from experience completing the SOA PA Certificate

Description: Increasing technology is available to create and disseminate educational resources worldwide. In response, this article advocates creation of open educational resources (OERs) that will benefit the actuarial profession with both recruitment and retention of members. Specifically, we describe OER contributions made at the University of Wisconsin-Madison and more recently through the ASTIN Academy, a working group of ASTIN, the non-life section of the International Actuarial Association. We advocate pushing boundaries and creating new ways of teaching effectively for the future. The innovative use of technology and open-source materials is a way to foster diversity, equity, and inclusion in the actuarial profession.

Description: This is a 4-hour predictive analytics competition. It will be developed by the PAF and Modeling section. The competition will use publicly available data and ask participants to predict the outcome. The person with the best prediction will win the competition. The competition can be done on an individual for team basis. We don’t allow more than 4 people on a team.

Description: In this article we examine the benefits and drawbacks of using a global surrogate of a black-box model. Are surrogates a comfortable middle ground that provide insurers high predictive power as well as model explainability?

Description: Health claims are not normally distributed. Claims Forecasting can be improved by understanding the entire distribution of plausible values of future claims, for example knowing there is an 80% chance future claims are between $340 and $375 PMPM. Confidence intervals around our estimates allow us to understand for each range around the best estimate (for example +/- 1%) what is the probability that future claims will fall in that range. Quantile Regression is a mathematical technique where you can estimate any percentile of the claims distribution you are looking for as a function of demographics, diagnosis indicators, prior cost variables, or other significant predictors. You can see which coefficients are important at different parts of the distribution. Individual and group distributions can be constructed. There are numerous applications in pricing and underwriting, stop loss, provider profiling, ACO target setting, allocation of group risk charges based on volatility, discounting strategy, and experience analysis.

Description: A significant fraction of insurance risk is characterized by the tail of the claims distribution, where we have much less data to model probabilities accurately. Ignoring the tails can lead to underpricing of tail risk and mispricing. Estimation of the tails can be complex due to a bias-variance tradeoff--the further out we go into the tail the more accurately we can model the extreme tail (lower bias) but the less data we have (increased variance). The statistical tools of Extreme Value Theory can be leveraged to more accurately estimate both the incidence and the severity of extreme events given that they occur. using the Generalized Pareto Distribution.

Description: As actuaries in health care, we spend most of our time focused on reviewing claims, enrollment and clinical data. That information is captured while patients are in health care facilities. Yet most people spend only a small fraction of their time in these facilities. This article explores what types of data are available to actuaries the provide a more holistic view of the member so that a members physical and emotional needs, the social determinants of health can be taken into consideration along with their clinical needs. Two uses cases are presented so actuaries can see how these types of analyses can be leveraged to improve clinical, operational, and financial performance of risk bearing health entities. Understanding the customer (member) not just the patient enables actuaries to provide new insights and values to our stakeholders across a wide range of business and risk applications.