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 (September 2018)

2018

• 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

• Modeling Long Term Healthcare Cost Trends – Update for 2018
  August
  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.
• 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

• Accuracy of Claims-Based Risk Scoring Models 
  October
• Massachusetts Health Insurance Reform
  August
• An Examination of Relative Risk in the ACA Individual Market
  August
• Risk Scoring in Health Insurance: A Primer 
  July
• Prescription Drug Use in an Individual Exchange Population
  April

2015

• A Practical Approach to Assigning Credibility to Group Medical Insurance Pricing 
  December
• Provider Payment Arrangements, Provider Risks, and their Relationship with the Cost of Health Care
  October
• Indications of Pent-up Demand
  April

2014

• Managing the Impact of Long‐Term Care Needs and Expense on Retirement Security
  December
• Evaluating Approaches for Adoption of Medical Technologies
  March

2013

• Evaluating ACO Efficiency: Risk Adjustment within Episodes  
  December
• Funding Public Health Insurance Plans Canada and Globally 
  December
• Measurement of Healthcare Quality and Efficiency: Resources for Healthcare Professionals Modeling Long Term Healthcare Cost Trends
  December
• Actuarial Model for Wellness
  November
• Issues in Applying Credibility to Group Long-Term Disability Insurance  
  October
• Sustainability of the Canadian Health Care System and Impact of the 2014 Revision to the Canada Health Transfer  
  September
• Group Long-Term Disability (LTD) Benefit Offset Study-2012  
  July 
• Nontraditional Variables in Healthcare Risk Adjustment 
  July 
• Simulating Health Behavior – A Guide to Solving Complex Health System Problems with Agent-Based Simulation Modeling
  June 
• Health Care Costs - From Birth to Death
  May
• Cost of the Newly Insured Under the Affordable Care Act
  March
• Validating the PRIDIT Method for Determining Hospital Quality with Outcomes Data
  March
• Risks & Mitigation for Health Insurance Companies  
  January

2012

• Implications of the Cost of End of Life Care: A Review of the Literature  
  December
• Uncertainty in Risk Adjustment    
  September
• Design and Implementation Considerations of ACA Risk Mitigation Programs  
  June

2011

• Complexity Call for Models Contest Winner
  November
• Obesity and its Relation to Mortality and Morbidity Costs  
  January

2010

• The Economic Measurement of Medical Errors
  August
• Potential Impact of Pandemic Influenza on the U.S. Health Insurance Industry  
  July
• Group Long–Term Disability Benefit Offset Reserving Practices Survey  
  June
• Complexity Science–an introduction (and invitation) for actuaries  
  June
• Enterprise Risk Management (ERM) Practice as Applied to Health Insurers, Self-Insured Plans, and Health Finance Professionals  
  January

2009

• Comparison of Incurred But Not Reported (IBNR) Methods
  October
• Group Long–Care Disability Benefit Offset Study  
  August
• Infliximab Therapy for Individuals with Crohn's Disease: Analysis of Health Care Utilization and Expenditures  
  January

2008

• Financial Reporting For Insurance Contracts Under Possible Future International Accounting Standards
  February

2007

• Statistical Methods for Health Actuaries–IBNR Estimates: An Introduction
  November
• Critical Review of Stochastic Simulation Literature and Applications for Health Actuaries
  October
• A Comparative Analysis of Claims Based Tools for Health Risk Assessment
  April

2006

• Linking Quality and Cost: An Analysis of the Hospital Quality Information Initiatives Measures
  November
• Variation by Duration in Individual Health Medical Insurance Claims
  July
• Health Plan Provider Network Risk
  June

2005

• Estimated Impact of Medicare Part D on Retiree Prescription Drug Cost
  December
• Evaluating the Results of Care Management Interventions: Comparative Analysis of Different Outcomes Measures Claims
  September
• Health Section Data Sources
  August
• Financing Chronic Care Monograph
  June
• A Comparative Analysis of Claims-based Methods of Health Risk Assessment for Commercial Populations
  May
• Linking Quality and Cost: An Analysis of the Hospital Quality Information Initiatives Measures (MPRO)
  January

2004

• Medical Large Claims Experience Study
  November
• Prescription Drugs Monograph
  October
• Evaluating Managed Care Effectiveness: A Societal Perspective
  January
• Evaluating the Reliability and Validity of the Health Plan Data and Information
  January
• Projected Cost Analysis of Potential Medicare Pharmacy Plan Designs
  January
• Study: Alternative and Complementary MedicineTroubled Health Care System
  January
• Troubled Health Care System
  January
• Predicting Return to Work with Data Mining
  January

2003

• Aging Curves for Health Care Costs in Retirement
  August

2002

• A Comparative Analysis of Methods of Health Risk Assessment
  July
• Group Medical Insurance Large Claims Database Collection and Analysis
  July