Description: Incorporating Pended Claims in Medical IBNR Estimates. Issue No. 45.

Description: Discussion of methods to estimate unpaid claim liability UCL for health plans. Includes traditional IBNR lag method and a lag method based on claims reported but not paid RBNP. Issue No. 45

Description: A closer look at family tier factor rating assumptions, and how well they reflect actual claim cost data.

Description: We highlight a new approach leveraging predictive analytics to identify high risk and rising risk opioid users for more effective screening and follow-up care.

Description: Excerpts from a conversation with Alan Mills regarding his work in complexity science and agent-based modeling.

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: Review of a research project, co-sponsored by the SOA, which examined 83 organizations and over 150 programs that measure the quality and efficiency of hospitals and physicians.

Description: Analysis of the impact of disease progression and treatment on life expectancy provides perspective on the long term costs to the health care system of chronic medical conditions.

Description: Review of a report by Alan Mills introducing Complexity Science, a discipline which could help actuaries to model and manage complex systems, such as the health care system.

Description: As providers are considering accountable and value based care models, it is critical to strategically think through how to achieve a sustainable business model into the future. This requires actuarial and clinical/provider capabilities to assess the care management and financial levers to help a client through the transition.