The Society of Actuaries Expands Research Capabilities with Health Care Cost Institute Data

Schaumburg, IL (September 25, 2018) -  As part of its commitment to conducting objective, data-driven research into pressing business and societal topics, the Society of Actuaries (SOA) today announced its inaugural research based on the Health Care Cost Institute (HCCI)’s extensive datasets.

In its inaugural research, the SOA analyzed seven-years of HCCI claims data to understand which characteristics predict future high-cost patients. The analysis found that cost-history, age, gender and prescription drug coverage are all indicators of future high-cost patients (members), with cost-history being the most predictive. Additional key findings include:

  • Member cost history had the biggest impact on the probability of a patient being high cost again, with the impact increasing as prior-year costs increase. 
  • Members are also more likely to be high cost as they age.
  • The effect of gender is relatively small, but female members are generally less likely to be high cost.
  • Members with prescription drug coverage are more likely to have higher claims, but this effect is also relatively small.
  • The exception to these trends is patients with $1 million+ in annual claims, since there tends to be more uncertainty with costs at this level.
  • Additionally, enrollment in the individual market did not have a significant impact, although it did make the member slightly less likely to exceed $100,000 or $250,000 in annual claims.

“The HCCI database is among the most robust collection of medical claims data the SOA has ever had access to,” said Dale Hall, FSA, CERA, MAAA, SOA managing director of research. “The magnitude of the database allows us to further an understanding of national health care cost and utilization trends, which may ultimately help lower health expenditures when combined with the appropriate interventions.”  

The SOA will continue to analyze HCCI data for future research projects through its ongoing commitment to arming actuaries with objective, data-driven research relevant to their field. Future analyses will explore additional health care cost and utilization trends, including further research into high-cost individuals, as well as analysis into the financial impact of preventative care. The SOA will publish new analysis on as it is available.

For more information on the SOA’s inaugural research using HCCI data, please visit /research-reports/2018/2018-predict-high-cost-hcci/.

About the Society of Actuaries

With roots dating back to 1889, the Society of Actuaries (SOA) is the world’s largest actuarial professional organization with more than 30,000 actuaries as members. Through research and education, the SOA's mission is to advance actuarial knowledge and to enhance the ability of actuaries to provide expert advice and relevant solutions for financial, business and societal challenges. The SOA's vision is for actuaries to be the leading professionals in the measurement and management of risk.