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.

Description: ACA Impact on Employers

Description: Panelists report on the status of activities by national associations in regard to risk-based capital requirements for health insurers. From the Record of the Society of Actuaries, Vol. 24, No. 2.

Description: This article begins with a comparison of the commercial risk adjuster to the exisiting Medicare model, and goes on to discuss why the existing strategies employed by health plans will not work in a risk adjusted environment. The article elaborates on the importance of diagnosis coding, controlling member mix, and care management in order to mitigate risks and gain from newly created opportunities.

Description: Introduction to additional actuarial research into development of and regulatory impact, economic impact and consumer impact of prescription drugs in the United States. Intended to further educate actuaries and others who work in this area and motivate more actuarial involvement to increase transparency, increase competition, better align stakeholder incentives and better mitigate total cost of care increases

Description: A Regulatory Perspective on Rate Review Before and After the Affordable Care Act

Description: Affordable Care Act and Payment Reform

Description: Risk adjustment is used to adjust the revenue stream to health insurers that sell ACA eligible plans and Medicare Advantage plans. This article compares and contrasts these risk adjustment programs.

Description: Read the March 2017 issue of Health Watch, published by the Health Section. Practical information for actuaries, articles impact sections, section activities.