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: The momentum in value-based care has produced an opportunity for actuaries to become pioneers in health care

Description: This is the second installment of an article about using microeconomics and the concepts of embedded value to better manage and understand the profitability of direct marketing programs.

Description: Methods and assumptions used in the valuation of savings by external care vendors

Description: Observations of a Home Health Care Experience Analysis incidence rates, selection rates, avg length of service. From Long-Term Care Newsletter, October 2000, Issue No. 3.

Description: Mortality data and results for care home residents in England and Wales. Looking at numbers of death may indicate that there are fewer rate, but diving deep into various sub segments and looking at death rates, tells a different story.

Description: This article discusses the positive aspects of E-prescribing, a transaction in which a physician transmits a prescription directly to a pharmacy through an electronic device. Issue No. 60

Description: The article provides an overview of the federal tax treatment of long-term care insurance contracts, including a brief history of the tax treatment of long-term care insurance, the requirements that must be satisfied in order to be treated as qualified long-term care insurance under the Internal Revenue Code, and a brief discussion of qualified long-term care combination products and chronic and terminal illness accelerated death benefits offered under life insurance contracts.

Description: This article incorporates the NAIC long-term care insurance model regulation to discuss the appropriateness of rate increases by monitoring emerging experience to manage the risk. This includes experience analysis issues, maximum rate increase calculations, business considerations and valuation issues. From Long-Term Care, December 2003, Issue 10

Description: Long Term Care Insurance Reserves and Reinsurance Balancing between statutory and GAAP requiements. From Long-Term Care Newsletter, August 2001, Issue No. 5.