Description: Yi-Ling Lin, FSA, MAAA, FCA, started the SOA’s Predictive Analytics Certificate Program to keep pace with the impact big data and predictive modeling is having on the health care industry

Description: Through the sponsorship of the Robert Wood Johnson Foundation, The Society of Actuaries partnered with Wakely to use their health care data to study the effects of COVID-19 on overall health care claims for individuals with a COVID-19 diagnosis. The conclusion of the study is that individuals with COVID-19 claims had significant increases in health care costs leading up to their months of diagnosis, as well as in the months following their diagnosis. These effects were more pronounced for individuals who were hospitalized due to COVID-19 as well as for individuals with prior co-morbidities. Finally, the overall health care costs of these members plateaued at significantly higher levels than their pre-COVID baselines. In fact, all the main membership cohorts experienced claim levels that were at least 20% higher than their pre-COVID starting points.

Description: In this session, Deana Bell, FSA MAAA provides a comprehensive introduction to the Medicare Risk adjustment Program. Deana is a Principal & Consulting Actuary in the Seattel office at Milliman. She has been working with Medicare Advantage throughout her career as an actuary. Her expertise includes actuarial opinions, pricing, rating, reserving, medical underwriting, benchmarking, and risk adjustment projects. IN this session she sheds light on how Medicare Advantage health plans are compensated by the Centers of Medicare and Medicaid Services (CMS) through risk adjusted revenue. She highlights the significance of risk adjustment in ensuring financial stability for Medicare Advantage plans. Contributors: Deana Bell, FSA MAAA ; David Koenig, FSA, MAAA, John Dawson, FSA, MAAA, Jon Forster, ASA, MAAA

Description: In this video Scott Allen, FSA, MAAA discusses the Medicare Advantage Part C bid template. The template helps Medicare Advantage plans estimate costs and premiums, comparing their bids to CMS benchmarks. It’s a complex process involving worksheets that project costs, calculate revenue requirements, and determine rebates, ultimately influencing the plan’s benefits, premiums, and competitiveness in the market. Contributors: Scott Allen, FSA, MAAA, Eric Milner, ASA, MAAA, Danica Turner, FSA, MAAA, Jon Forster ASA, MAAA

Description: Kevin Pierce, FSA MAAA divesinto the Inflation Reduction Act’s impact on US drug pricing. He discusses two key provisions: Inflation rebates, where pharmaceutical manufacturers must pay rebates to the government if drug prices rise faster than inflation, and drug price negotiation by Medicare, set to commence in 2026 for selected drugs. Contributors: Kevin Pierce, FSA, MAAA, Deana Bell, FSA, MAAA Mitchell Momanyi, FSA, MAAA, Jon Forster, ASA, MAAA

Description: The SOA Research Institute Catastrophe and Climate Strategic Research Program released a report that explores the shifting geography of Lyme Disease in the U.S. and beyond and some of the potential determinants of its spread. Lyme Disease is a well-known disease particularly in the eastern U.S., and it is also prevalent in other geographies. This report researches the complex relationship between climate variables and the spread of Lyme Disease in the United States.

Description: The SOA Research Institute Catastrophe and Climate Strategic Research Program released a report that explores the shifting geography of Lyme Disease in the U.S. and beyond and some of the potential determinants of its spread. Lyme Disease is a well-known disease particularly in the eastern U.S., and it is also prevalent in other geographies. This report researches the complex relationship between climate variables and the spread of Lyme Disease in the United States.

Description: This section contains multiple book reviews and notices concerning the actuarial profession. Reviews: 'Medical Risks: Patterns of Mortality and Survival' by Singer and Levinson, 'The Theory and Practice of Pension Funding' by Trowbridge and Farr, 'Two Stochastic Processes' by Beekman, 'Disability Income Insurance - Cost Differentials between Men and Women' by New York Insurance Department, 'Social Security and Private Pension Plans: Competitive or Complementary' by McGill, 'A New Look at Accounting for Pension Costs' by Hall and Landsittel, '1977 Annual Reports of the Board of Trustees of the Federal OASDI Trust Funds...,' 'Investigation of Sickness Statistics - Individual Policies, 1971 and 1973' by the Institute of Actuaries and the Faculty of Actuaries, 'The Graduation of Pensioners and of Annuitants Mortality Experience 1967-70' by the Institute of Actuaries and the Faculty of Actuaries, 'Pensions and Survival - the Coming Crisis of Money and Retirement' by Calvert, 'Group Benefits in a Changing Society' by Spencer, 'Experience of Disabled Work Benefits under OASDI 1965-74' by Bayo and Wilkin. Digests also included.

Description: In this, the second step, Sibson engaged the vendor and actuarial communities to solicit input on the actuarial model for determining the impact of various environmental, lifestyle and behavioral risk factors. The goal was to understand the extent to which actuaries currently use models around wellness, refine the above conceptual model, and better understand the potential uses of, and value to, the actuarial and vendor communities that would use such a model. We sought to understand the potential applications and sources of data for the actuarial model. We gathered input on how the model would best suit the professional needs and help shape the future role of the actuary. Lastly, we gathered feedback on the above conceptual model.

Description: This Society of Actuaries Research Brief has been constructed to highlight some of the key features of the pandemic and contemplate the risks for the actuarial profession to consider in their work.