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Health Research Reports

If you’re looking for research projects and reports on health topics, you’ve come to the right place. The SOA offers research, authored by an individual or a team of authors, for download in just a few clicks. Most reports are in PDF format.

Highlights of SOA Health Research Projects (August 2019)

2021

  • 2022 Health Care Cost Model
    April

    The Society of Actuaries (SOA) created the SOA 2022 Health Care Cost Model (model) to enable users to estimate future U.S. health care insurance costs. This model allows a user to consider a variety of scenarios and create inputs that can forecast the impact on the health care service system. The model will be updated periodically to reflect the latest data on both the outbreak and insurance health care costs. A user guide, user training video and model documentation guide have also been developed to support the model.

  • An Actuarial Perspective on the Relationship of Patient Centered Medical Homes and Healthcare Costs
    March

    This paper helps the audience understand the actuary’s role in estimating the financial impact of primary care programs. In addition, the paper can be used by actuaries to think about key issues when estimating the financial impact of their employers’ and clients’ own primary care programs.

  • Determining the Role of Anthropogenic Climate Change on Human Health Outcomes: A Case Study on Heat Related Illness Attribution
    February

    This report is targeted to actuaries that are interested in identifying the adverse human health outcomes resulting from anthropogenic climate change. As the primary focus of actuarial research is to promote human health and minimize the preventable economic burden, this document also provides recommendations to mitigate against excess heat related illness (HRI) due to extreme heat.

  • Modeling Effects of Enrollee Choice
    January

    In health insurance marketplaces, prospective insured individuals and groups are able to choose from a range of available plans. This study uses health care encounter data to simulate the choices faced by health insurance shoppers under a variety of conditions and measures the simulated effect of increased consumer choice and consumer information on medical loss ratios and, as a consequence, insurer profitability.

2020

  • COVID-19 Mitigations in the U.S.
    December
    This report provides highlights of a weekly survey of practices regarding the mitigation of the spread of COVID-19.
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  • Comparing Measures of Social Determinants of Health to Assess Population Risk
    November
    Social Determinants of Health (SDOH) include the social and physical conditions in which people are born, live and work on a daily basis. This project advances a growing body of literature to inform the ongoing optimization of population health and payment models.
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  • Getzen Model of Long-Run Medical Cost Trends Update for 2021–2030+
    October
    An update to the Getzen Model of Long-Run Medical Cost Trends for 2021–2030+.
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  • 2021 Health Care Cost Model
    June
    The Society of Actuaries (SOA) created the SOA 2021 Health Care Cost Model (model) to enable users to estimate future U.S. health care insurance costs. This model allows a user to consider a variety of scenarios and create inputs that can forecast the impact on the health care service system. The model will be updated periodically to reflect the latest data on both the outbreak and insurance health care costs. A user guide, user training video and model documentation guide have also been developed to support the model.
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  • Society of Actuaries Research Brief: Impact of COVID-19, June 12, 2020
    June
    This Society of Actuaries Research Brief has been constructed to highlight some of the key features of the COVID-19 epidemic and contemplate the risks for the actuarial profession to consider in their work.
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  • Direct Primary Care: Evaluating a New Model of Delivery and Financing
    May
    The Society of Actuaries (SOA) commissioned Milliman to develop this report to provide health care stakeholders (patients, payers, policymakers and actuaries) with a comprehensive description of Direct Primary Care (DPC) as well as an objective actuarial evaluation of certain claims made about the DPC model of care.
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  • Projections of COVID-19 Hospitalizations and Deaths, Updated April 24, 2020
    April
    Since the outbreak began in January, numerous research groups throughout the world have developed models to forecast the number of deaths that could result from COVID-19. Dr. Thomas McAndrew and Dr. Nicholas Reich of the University of Massachusetts Amherst have, on a weekly basis beginning in mid-February, surveyed experts who are separately engaged in efforts to model the outbreak. This brief looks at these models.
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  • Mental Health Trends and COVID-19
    April
    With the pandemic outbreak of coronavirus disease (COVID-19) through the world in the first part of 2020, many resulting outcomes have triggered the potential to see an increase in the use of mental health benefits in health care insurance systems.
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  • COVID-19 Costs to Commercial Health Insurers
    April
    Due to the COVID-19 pandemic, the health care services industry is undergoing upheaval with ramifications on many different aspects, from access to services, to cost and utilization of services.
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  • A Summary of the Health Care Cost Institute’s 2020 Annual Cost and Utilization Report
    February
    The Health Care Cost Institute (HCCI) recently released their annual health care cost and utilization report on February 13, 2020, which illustrates employer group commercial health care costs and trends from 2014 – 2018. This reports summarizes the HCCI report.
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2019

  • A Summary of the Latest Updated Medical Loss Ratio Methodology and Historical Results
    December
    The SOA is releasing this brief report which summarizes the most current Medical Loss Ratio (MLR) methodology highlighting some of the most recent changes in methodology and requirements.
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  • Getzen Model of Long-Run Medical Cost Trends Update for 2020–2029+
    October
    A divisive confrontation over health care pricing is almost inevitable over the next few years. What will ultimately happen is a political decision, not an actuarial one—but it will have major consequences for the trend in health care costs and the divergence between public and private insurance premiums.

  • Economic Impact of Non-Medical Opioid Use in the United States
    October
    This report summarizes a study that estimates the total economic burden of the opioid crisis in the United States from 2015 through 2018 and projects future costs of the opioid epidemic for 2019.

  • Health Plan Strategic Implications of MACRA
    August
    The SOA is pleased to make available a research report providing insight and considerations for the actuarial profession in assessing the potential risk and opportunities of MACRA to both provider and payer organizations.

  • Commercial Health Care Cost and Utilization Trends From 2009–2015
    July
    Health care cost trends are a key ingredient that health care actuaries use in their practice. In collaboration with the Health Care Cost Institute (HCCI), the Society of Actuaries has put together a data extract for practicing health actuaries to be able to better understand historical trends and cost disruptors.

  • Cancer Genomics 
    May 
    The treatment of advanced cancer is undergoing a major paradigm shift. Traditional pillars of cancer treatment – surgery, radiation, and chemotherapy – are moving to two new efficacious approaches: tumor genomics and immunotherapy. This analysis report introduces SOA stakeholders to these brand-new areas, examines the growing clinical evidence, and sets initial projections for cost effectiveness.

  • A Summary of the 2020 Actuarial Value Calculator 
    April 
    The Centers for Medicare and Medicaid Services (CMS) recently released the final 2020 Actuarial Value Calculator and Actuarial Value Calculator Methodology.

  • HCCI Annual Health Care Cost and Utilization Report Summary Analysis 
    February 
    This is a summary analysis of the Health Care Cost Institute’s annual health care cost and utilization report from February 12, 2019.

2018

  • Evaluating Payment Models for High-Cost Curative Therapies
    October
    The SOA is pleased to make available a research report that evaluates alternative payment models that potentially could be instituted by health care payers and manufacturers to pay for high-cost curative disease therapies and prescription drugs.

  • Hospice Care Research: An Analysis of End-of-Life Costs for Terminally Ill Medicare Fee-for-Service (FFS) Cancer Patients
    October
    The SOA is pleased to make available a research report analyzing the cost of care for deceased cancer patients over the last six months of life. The analysis focuses on the cost differential of hospice care versus not entering hospice for such patients.

  • Modeling Long Term Healthcare Cost Trends – Update for 2019
    October
    The Society of Actuaries' Pension Section and Health Section Research teams originally commissioned Professor Thomas E. Getzen of Temple University to construct a resource model for the projection of long term healthcare cost trends.  The Society of Actuaries continues to make annual updates to the model to ensure its usefulness and relevancy.

  • Predicting High-Cost Members in the HCCI Database
    September
    Using the Health Care Cost Institute (HCCI) database, which contains claim information on approximately 47 million members annually over a seven-year time period, we examined which characteristics best predict and describe high-cost members.

  • Patient Attribution
    September
    This paper describes the key elements of attribution methodology, identifies the challenges and opportunities associated with each and discusses key considerations related to risk and risk transfer from payers to providers.

  • Analysis of Individual Disability Income Tables
    August
    The Society of Actuaries Health Section Research Committee is pleased to make available the first of two reports analyzing industry Individual Disability Income (IDI) claim incidence and termination experience trends relative to the 2013 IDI Valuation Table base incidence and termination rates. The first report covers claim incidence trends.

  • Examining Predictive Modeling-Based Approaches to Characterizing Health Care Fraud  
    March
    The Health Section Research Committee is pleased to make available a research report providing a systematic evaluation of the modeling methodologies and data samples used to characterize health care fraud.

  • Model of Long-Term Health Care Cost Trends in Canada  
    March
    The Canadian Institute of Actuaries (CIA) and the Society of Actuaries (SOA) are pleased to make available a resource model that provides long-run (to 2050 and beyond) forecasts of health care spending in Canada.

  • Provider Networks – Actuarial Perspective on Performance In and Out of Exchanges
    March
    The Health Section Research Committee and the Health Section are pleased to make available a research report describing aspects of provider network performance in health care settings with particular focus on experiences with Exchanges.

  • Actuarial Review of Insurer Insolvencies, Future Preventions  
    January
    Sponsored by the Canadian Institute of Actuaries (CIA), Casualty Actuarial Society (CAS), and Society of Actuaries (SOA), this study looks at causes of insolvency and decisions made by management, regulators, and policyholders over the life cycle of the insolvency. This study is intended to educate insurance professionals on historical insurer impairments and insolvencies and possible future prevention indicators.

  • Insurance Risk and Its Impact on Provider Shared Risk Payment Models
    January
    The Society of Actuaries Health Section is pleased to make available a report examining the risk associated with the unpredictable variation in utilization and cost of services.

2017

  • Medicaid Managed Care Organizations: Considerations in Calculating Margin in Rate Setting
    March
    The Society of Actuaries Health Section Research Committee is pleased to make available a research report that describes the components of margin for calculating capitation rates in a Medicaid context along with a description of practical issues that may be encountered by MCO’s. The report includes observations from interviews with MCO executives as well as financial results analysis of MCOs nationwide.

  • Opioid Overdose Deaths in the United States
    February
    The Society of Actuaries is pleased to make available an article describing the demographics and geography of the increasing number of opioid deaths in the United States. The article summarizes data available from the Centers for Disease Control.

  • A Case Study of Risk Adjustment for Texas Medicaid
    February
    The Society of Actuaries Health Section is pleased to make available a research report that examines the impact on risk scores in risk adjustment models when there are timing differences for model updates of pharmacy data and risk factor mappings. The analysis was done through a case study of Texas Medicaid using the CDPS (Chronic Disability and Payment System) risk adjustment model.

2016

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