Description: According to the Actuarial Standards Board’s Actuarial Standard of Practice No. 49 (ASOP 49), actuarially sound Medicaid managed care capitation rates will include a provision for underwriting gain in order to provide compensation for the risks assumed by an MCO. However, there is no generally accepted method for quantifying underwriting gain in managed Medicaid capitation rates. This article discusses a new model developed to address this void and calculate underwriting gain. The model was developed by researching existing financial literature and performing a statistical analysis of industry data to build out a framework that can be leveraged to estimate underwriting gain.

Description: Comparison of healthcare costs for early retirees versus active workers in the same age band. When adjusted for age, there is not a significant difference in costs between each group.

Description: Discussion that developing credibility factors for group health insurance can be accomplished empirically through the use of stochastic models with appropriate parameters and fairly readily obtainable data, without the need for unrealistic assumptions.

Description: Article presents issues for postretirement medical on models, data and the frail elderly. From Health Section News, December 2000, Issue No. 39.

Description: An approach to quantify medical intervention savings when medical claims data is not available by leveraging overlapping measurement techniques.

Description: This article discusses the use of parametric distributions to model health care cost.

Description: This article discusses the advantages, logistical concerns, and pricing formulas of implementing a TNHP, in which members pay less for treatment from providers who meet higher quality and cost-effectiveness standards.

Description: In this article, the author discusses the considerations and advantages of implementing an integrated enterprise risk management program for a health insurance company, and presents a summary of Aetna's experience with ERM as a case study.

Description: This article discusses challenges that short-term predictions have on actuaries' reputations, both as individuals and as a profession, and discusses strategies to improve our professionalism and better manage this risk.

Description: An economic analysis of bariatric surgery and health care costs supports the case for health plans to cover these procedures.