Description: In this paper the authors analyze data from group medical expense insurance claims and show that many insurance loss distributions have very 'heavy tails' because large losses represent a disproportionate fraction of the total cost. They also present a simple model to reproduce and explain the large loss behavior. From Actuarial Research Clearing House 1990, VOL. 2

Description: This Fellowship credit research paper describes the use of fuzzy sets applications to the selection of group health risks. In general, fuzzy set theory is implemented to describe collections of objects whose boundaries are not precisely defined, as in the judgment of what constitutes a good risk group. First, single-plan underwriting is considered, then the work is extended to multiple-option plans.

Description: With the mandated health plan transparency files, health plans and providers are now able to substantially enhance their provider contracting efforts. Although the files are large and cumbersome they are market disruptors and provide new insights for provider contracting efforts. Explore a demonstration on the type of information now available and how it can be used to enhance this from both a health plan and health care provider perspective.

Description: Attend if you are an organization interested in utilizing various kinds of client data to improve the whole insurance sales process, and to develop new applications. Interested parties may include distribution sales force, underwriting, claims, actuarial and finance departments within a typical insurance company, online distribution partners, health care providers and other consulting service providers. The research looks into various use cases, which are typically main issues in modeling in the insurance industry. The research also helps benchmark performance using different languages that may serve as a good reference when best to use a certain language to enhance the development cycle.

Description: Modeling Approaches and Challenges focuses on approaches to real world simulation and the challenges and considerations in real world simulation. Topics include: A frequency domain approach to build realistic multi-horizon scenarios. (Ortec approach) Cascade models structure linking models for major asset classes and economic variables. (Moody’s approach) Overview of models, calibrations & approaches within the context of different use cases. Deterministic & stochastic approaches. Importance of model re-calibration flexibility. We will also discuss specific insights into considerations and challenges in real world simulation, which include topics like: Setting capital market assumptions and/or calibration targets. Assumptions about correlation and causality. Calibrating the model to capital markets assumptions. Validating the model against capital market assumptions. Role of history, market data and stylized facts. Importance of back testing. Calibrating the model to multiple investment horizons. Inclusion of alterative asset classes such as private equity, infrastructure, and direct real estate. Associated issues of limited data, illiquidity and greater uncertainty about calibration targets.

Description: Hear about some applications using quantile regression-derived individual and group claim distributions and how they may be used in various traditional health care modeling situations. The session will not focus on the technical use of quantile regression to obtain estimates of claim distributions, but more so is intended to focus on the uses of the distributions in actuarial modeling and the additive framework in assessing claims distributions. Presenters will show how actuaries can better assess risks by focusing on the individual- and group-specific claims distributions as opposed to traditional point-estimate-centric models.

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: From a session at the 2000 Valuation Actuary Symposium held in Washington DC, September 14-15, 2000 Discussion of financial modeling considerations including: • Model platforms • Model structure • Static and dynamic model validation techniques • Data integrity

Description: Data is at the core of the actuaries' role within companies, but how can actuaries translate data insights into informed and actionable decision making? The key is communicating data insights into a language that transcends analysis and enables real-time decisions that can provide an advantage to your management team. Learn an approach to choosing a tool or medium for your data insights, questions to ask yourself to better understand the communication necessary, and perspectives on how actuaries can take a larger role in actionable decisions within the industry. Understand availability, quality, and practical application of data sources health actuaries can access easily, how that data looks, approaches to transforming data into decisions, how it enriches administrative and claims data, and applications to pricing and reserving. Finally, discuss implications of ASOP 23, ASOP 41, and ASOP 56 as it relates to this topic. By attending this session, you will be able to: - Create an action plan on how to transform data into messaging for your leaders. - Use real experiences to formulate a strategy to expand the actuaries' role in informing decisions within the industry, including examples, to illustrate how data can benefit financials of health coverages. - Understand the application of ASOP 23 (Data), ASOP 41 (Communication), and ASOP 56 (Modeling) as it relates to turning data into decisions. - Be knowledgeable about new sources of morbidity for medical care and LTC and how to acquire and apply this information in actuarial models.

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