Description: Report from research project that reviewed and inventoried the range of quality and efficiency measures that demonstrate the performance of hospitals and physicians. Besides outlining key areas of consideration for quality and efficiency measurement, this report also describes future opportunities for actuaries and other health professionals interested in this evolving area. The inventory part of the report is in a separate document.

Description: Candidate questionnaire for Patricia Fay, 2020 candidate

Description: Sue Blanck is an endorsed candidate for elected Board Member for SOA's 2017 elections. Read her candidate questionnaire.

Description: This is the Health Section News, August 2005, Issue 50 and discusses accessing and using public data: A primer for the health actuary. Health data no longer is an afterthought but it is an essential component of health care delivery, payment and decisions.

Description: IFRS 17 will be effective as of 1 Jan 2023 and provide opportunities as well as challenges to both Direct Writers and Reinsurers across the insurance industry. If the new framework is not fully understood, an implementation can elevate the risk of problems in financial reporting, product development, investment management and more. The transition to IFRS provides an opportunity for companies to optimize the financial position of the enterprise by implementing mitigating strategies to reduce the risks and challenges that IFRS brings to the table.

Description: Medicare-Advantage Organizations (MAOs) are often under intense pressure to increase revenue. The ACA dramatically changed the incentives by which MAOs achieve financial success. With benchmark rates growing only as fast as FFS Medicare rates, many MAOs rely on risk scores and quality bonuses as their primary source of additional revenue.There are a not insignificant number of MAOs that are either under scrutiny by federal investigators, exposed to whistleblower lawsuits, and some even paying large penalties to resolve False Claims Act liability for providing inaccurate risk adjustment information (e.g., $270 million paid by Healthcare Partners/DaVita Medical Holdings in October 2018).Is it possible to operate a risk adjustment program that is both compliant with applicable federal regulations and sub-regulatory guidance yet still generate the revenue to ensure that Medicare-Advantage plans are financially viable in the marketplace? The presenters believe that not only is true compliance (as opposed to the mere appearance of a compliance program) a requirement for success, it is a necessary pre-condition for both MAO profitability and to ensure that risk scores are an accurate representation of member morbidity.

Description: Recently researchers, practitioners, and regulators had intense debates about how to treat the data collection threshold in operational risk modeling. There are several approaches under consideration—the empirical approach, the “naive” approach, the shifted approach, and the truncated approach—for fitting the loss severity distribution. Since each approach is based on a different set of assumptions, different probability models emerge. Thus, model uncertainty arises. When possible we investigate such model uncertainty analytically, otherwise we use Monte Carlo simulations. For specific parametric examples we consider exponential and Lomax distributions which are special cases of the generalized Pareto family. Our primary goal is to quantify the effect of model uncertainty on risk measurements. This is accomplished by evaluating the probability of each approach producing conservative capital allocations based on the value-at-risk measure. These explorations are further illustrated using a real data set for legal losses in a business unit (Cruz, 2002).

Description: Panelists at this session of the SOA 1995 Vancouver Spring Meeting present ways to measure physician performance and the issues associated with gathering the data for doing so.

Description: This is the fourth in a series of articles about accounting for reinsurance under GAAP Targeted Improvements to the Accounting for Long-Duration Contracts (LDTI). It looks at some concerns that arise from the relationship between ceded reinsurance and the underlying contracts. Recognizing a lack of formal guidance addressing these concerns, the article aims mostly to achieve performance and simplicity objectives

Description: Overview on current trends in medical practice impacting the LTC insurance business with a focus on dementia, risk stratification, and predictive modeling.