Description: CMS provides ACOs with monthly claims data for members, including their medical visits and ACO program eligibility. This data can be divided into Membership and Claims tables through the ETL process. However, when calculating PMPY at specific levels of detail using these tables, issues arise due to unrelated dimensions, leading to inaccurate and understated results. This article presents a solution to this problem by utilizing Tableau's data blending capabilities.

Description: Regression to the mean is a phenomenon that arises when comparing sequential data points. It states that when an initial observation is extreme or an outlier, future observations will be closer to the average. Health care actuaries need to understand and be able to mitigate the effects of regression to the mean to avoid misapplying predictive models or misstating measurements of historical effects.

Description: Read the April 2020 issue of The Modeling Platform, published by the Modeling Section. Newsletters provide practical information for the working actuary, articles on trends that impact sections and news about section activities.

Description: This is the second part of a 2 part series on Real options analysis (ROA). This article looks into the limitations of using financial option theory when doing real options analysis with projects that are long-dated and uncertain, such as: 1. First-degree homogeneity, 2. Uncertainty must derive from Brownian motion, and 3. Risk neutrality.

Description: Presents a step-by-step methodology for calculating confidence intervals for IBNR estimates derived using the Averaqe PMPM method. It is a companion article to the January 2023 Health Watch article presenting the Average PMPM method for generating point estimates of IBNR with zero claims runout.

Description: 2011 Enterprise Risk Management Symposium, Chicago. This study investigates whether simulation-based models can be used to predict liquidity risk for banks, which must comply with Basel III by January 2015. The paper looks at the process of developing a measurement framework using Black-Scholes and Merton’s asset-based models to measure liquidity risk.

Description: The purpose of this article is to provide a high level summary of the paper “Variance of the CTE Estimator” by B. John Manistre and Geoffrey H. Hancock that appeared in the North American Actuarial Journal in 2005. The authors also expanded on some of the results.

Description: The method described in this paper is to allocate surplus to each category of business and reserves in proportion to its estimated effect on an insurer's surplus variation. Risk load for each category of business is then selected so that the return on allocated surplus for each category is equal to the overall return on surplus. From Actuarial Research Clearing House 1993, VOL. 3.

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

Description: This webcast will focus on recently published health research which examines the impacts of social determinants of health on oral health outcomes as well as on chronic kidney disease progression. Participants will gain insights on how different aspects of social determinants of health can impact how healthcare is delivered as well as the impact on health care costs.