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: This report has been assembled by the Task Force as a comprehensive guide to practicing actuaries in evaluating the impact of AIDS on the solvency of life and health insurance companies in the US and Canada. From Transactions of Society of Actuaries 1988, Vol. 40, Pt. 2.

Description: Describes a process to develop a good forecast. Also provides an example.

Description: This article discusses the potential characteristics of health care reform and the associated impact on small insurance companies.

Description: This 1978 session focused on regulatory considerations in Group Health Insurance focused on the following questions: 1. What is the impact of National Health Insurance and Federal Hospital Cost Control? 2. What is the impact of non-discrimination legislation and regulation? 3. What is the impact of recent OASDI financing changes and changes in mandatory retirement age? 4. What is the future of multi-employer trusts and self-insurance?

Description: This discussion on individual sickness and accident insurance looks at the experience under major medical expense contracts with reference to sales, underwriting, claims and administration. The discussion also reviews the safeguards used for underwriting hospital expense coverage beyond age 65 and loss of time coverage for women.

Description: Presented at April 1986 Spring Meeting. This session discussion is about the impact of wellness programs on medical plan experience/non-medical plan experience, health status as a pricing variable, likely future developments.

Description: This 1978 panel discussed risk classification systems for a variety of products. Topics covered included: 1. regulatory and social policy encroachment on risk classification systems 2. possible changes in underwriting/marketing strategy because of changed regulatory requirements 3. use of the social imperative via regulation or legislation to mandate availability of coverage to high risk classifications 4. implied use of the risk classification system to provide incentives to control socially undesirable behavior 5. potential use of private mass coverage to minimize the impact on risk classification systems for coverages mandated by law or social policy 6. the ultimate in risk classification systems: self-insurance