Description: Article presents issues for postretirement medical on models, data and the frail elderly. From Health Section News, December 2000, Issue No. 39.

Description: This article describes Medicare Supplement and short-term care products in more detail, and we compare their risk profiles. We explore the concept that these two products—when offered together—may provide a complementary hedge of certain policyholder behavior risks.

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

Description: The editor of HealthWatch addresses the readership on actuarial best practices and purpose of ASOPs. Issue No 60

Description: According to the Actuarial Standards Board’s Actuarial Standard of Practice No. 49 (ASOP 49), actuarially sound Medicaid managed care capitation rates will include a provision for underwriting gain in order to provide compensation for the risks assumed by an MCO. However, there is no generally accepted method for quantifying underwriting gain in managed Medicaid capitation rates. This article discusses a new model developed to address this void and calculate underwriting gain. The model was developed by researching existing financial literature and performing a statistical analysis of industry data to build out a framework that can be leveraged to estimate underwriting gain.

Description: This article discusses the positive aspects of E-prescribing, a transaction in which a physician transmits a prescription directly to a pharmacy through an electronic device. Issue No. 60

Description: Health claims are not normally distributed. Claims Forecasting can be improved by understanding the entire distribution of plausible values of future claims, for example knowing there is an 80% chance future claims are between $340 and $375 PMPM. Confidence intervals around our estimates allow us to understand for each range around the best estimate (for example +/- 1%) what is the probability that future claims will fall in that range. Quantile Regression is a mathematical technique where you can estimate any percentile of the claims distribution you are looking for as a function of demographics, diagnosis indicators, prior cost variables, or other significant predictors. You can see which coefficients are important at different parts of the distribution. Individual and group distributions can be constructed. There are numerous applications in pricing and underwriting, stop loss, provider profiling, ACO target setting, allocation of group risk charges based on volatility, discounting strategy, and experience analysis.

Description: Discussion of issues from The Credibility Task Force for Health Coverage. From Health Section News, June 1998, Issue No. 35.

Description: Investigation of High Deductible Trend by G. Russel Hugh from Health Section News, January 2002, Issue No. 42.

Description: Unpaid Loss Reserve fair and reasonable test and two legal cases Utah Medical and Minnesota Lawyers Issue No. 39.