Description: Early in his career, Ehren Nagel, FSA, MAAA, scoured through podcasts and articles about predictive analytics, long suspecting this was a field with potential for him.

Description: The SOA’s Health Care Cost Trends Strategic Research Program highlights trends in health care costs and high cost claimants, impacts of population driven risk factors on health care costs and innovative approaches to keeping costs in check.

Description: A compilation of feedback from actuaries in the Health Section of the affects of the ACA.

Description: This research report provides an evaluation and synthesis of the methodologies and data samples used on characterizing health care fraud.

Description: The Society of Actuaries has developed and released a health care forecast model to illustrate the potential impact of the COVID-19 outbreak on insurance plan health care costs in the United States. Users of the model may include insurance company actuaries seeking an additional reference point for 2021 cost development, regulatory actuaries seeking additional insights and validation of costs as part of rating submissions for 2021, and insurance purchasers seeking a deeper understanding of the forces driving 2021 health care costs and premiums. The model is not intended as a replacement for existing modeling tools developed by insurers or regulators. Rather, the model’s primary purpose is to illustrate the key outbreak-related forces that are affecting the trajectory of health care costs. In addition the model can provide a common reference point to facilitate dialogue with respect to the regulatory review of 2021 health insurance rate filings.

Description: Paper on the number and growth of the uninsured and underinsured in health insurance. Reviews literature on the following items trends in the number of uninsured, state policy activities, disparities in access, health care access and the health care safety net.

Description: The purpose of this document is to inform the user of the 2021 Health Care Cost Model about the sources of data, other reports, and assumptions which were used to populate this report and drive some of the key considerations.

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