Description: A new health insurance pricing model takes external market prices into account, as well as regulatory rate restrictions and other traditional pricing factors. Rather than being assumed at the outset, lapse rates emerge from the model, along with assessment spiral & loss ratio projections. Under the model optimal pricing strategy depends on whether the class being rated has a healthier than average mix of risks.

Description: Health Watch, Issue 79, December 2015, Health Watch

Description: This article is focused on sustainability concerns in the ACA individual markets and what we can learn from core actuarial principles as discussed in ASOPs.

Description: Summary and analysis of the diseases and conditions exhibited in the Medicare Advantage population

Description: The purpose of this study is to evaluate the predictive accuracy of the commercially available claims-based risk assessment tools under different sets of conditions and with different sets of available information.

Description: A summary of pathology, risk factors, treatments, public health issues, and economic costs of Alzheimer's Disease.

Description: The advent of machine learning algorithms has taken predictive analytics and risk scoring to a new level. From gradient boosting machines to k-nearest neighbors regression, the use of these techniques has gained significant traction in healthcare - including health systems like the Cleveland Clinic. This session will discuss the use of predictive analytics to go beyond just assessing the risk of a patient, and instead focus on prescribing a specific intervention of care. In practice, the recommendation of a care plan goes beyond just attributing a score to a patient. It provides physicians and care coordinators the most probabilistic options - e.g. referral to social worker, depression screening, weight-loss program - for positively impacting a patient's future healthcare outcome.

Description: Managed Care Risk-Based Capital new formula for HMOs and BCBS plans, modification of disability income, LTC and stop loss factors, market uses of RBC, company use of RBC Issue No. 37.

Description: Editor's comments on the publication

Description: Introduction sets out the objectives of comparing the predictive accuracy of different risk assessment methods, comparing the different methods based on other criteria, and then examining issues related to high-cost individuals and conditions. From A Comparative Analysis of Methods of Health Risk Assessment, M-HB96-1.