Description: This paper investigates the accuracy of loss reserves by comparing some reserves with the actual results five years hence. The ultimate purpose was to provide an estimate of the amount of variability which cannot be explained by listed factors. The resulting amount of variability gives an indication of the amount required for a provision for adverse deviation. From Actuarial Research Clearing House 1991, VOL. 1

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

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: This paper presents a method for analyzing the experience of a stop-loss underwriter to develop a claim continuance table. This method is designed to deal with the limitations presented from certain limited information so as to get the most out of the available information. To the extent this approach is succesful, the credibility of the experience analysis will be maximized, thus minimizing the reliance on external data. From Actuarial Research Clearing House 1993, VOL. 3.

Description: This paper presents a procedure for calculating aggregate stop-loss premiums that takes parameter uncertainty into account. From Actuarial Research Clearing House ARCH 1988, Vol. 3

Description: On average, contracts receiving their first star rating receive 3.20 stars, compared to existing or established contracts receiving 3.90 stars on average. This 0.70 disparity in quality ratings creates significant hardship on new contracts when this lower star rating decreases their payments in the following calendar year. This article explores the disparity in Medicare Advantage Star Ratings between contracts receiving their first star ratings (“New” contracts) and existing contracts, including: 1. Understanding what happens to Medicare Advantage Payments when contracts receive lower star ratings? – What is the Star Rating cliff and why does it matter to new contracts? 2. Explaining when a contract receives their first star rating and how much enrollment this requires – When does the Star Rating cliff occur? 3. Noting which specific star measures “New” contracts struggle with, including those contracts under large parent organizations, contracts with rapid growth, and all other new contracts. – How can my contract avoid the Star Rating cliff?