Description: The SOA’s research objective is to provide guidance to state exchange officials and administrators, federal officials and administrators, and actuaries assisting states and health plans. The goal of the project is to estimate the morbidity and/or cost for newly insured individuals in the individual market (and to some degree, the small group exchange) relative to the morbidity and/or cost for the current commercially insured population. This analysis will primarily focus on the individual, non-group market. In order to plan for the impact that these currently uninsured individuals will have on the health insurance markets, it will be important to understand their costs relative to the costs for people already enrolled, for whom many health insurers have experience and data.

Description: The Canadian Institute of Actuaries (CIA) and the Society of Actuaries (SOA) are pleased to make available a resource model that provides long-run (to 2050 and beyond) forecasts of health care spending in Canada. The material was authored by Michel Grignon, Byron Spencer, and Li Wang of McMaster University.

Description: This paper describes an actuarial methodology [adjusted average per capita cost - AAPCC] developed to meet the requirements of the risk contract that the medicare program makes available to certain health maintenance organizations. From Transactions of Society of Actuaries 1981, Vol. 33.

Description: A review of literature regarding care management program outcomes - either financial or utilization-related which are indicative of financial improvement or from which financial conclusions may be drawn. Includes a discussion on utilization & concurrent review, case & demand & population & disease management . Paper 3 of an 8 paper series on 'An Introduction to Care Management Interventions and Their Implications for Actuaries'.

Description: This article discusses the details of being classified as cognitively impaired, particularly the relationship between being classified as cognitively impaired and subsequent mortality experience and the effect of cognitive impairment on mortality rates.

Description: The objective of this project is to summarize the existing literature on end of life issues of interest to actuaries, and to document a broad list of such articles. The end of life issues explored are multi-dimensional and from multiple perspectives. When considering cost implications of end of life care, it is necessary to consider cost in a broad context as it is a measure that cannot solely be defined by dollars. Other dimensions of cost, such as quality of care, family care giving, communication, patient preferences and access to care, should also be explored.

Description: Using the Delphi method, this study explores the opinions of various Long-Term Care experts and stakeholders on a wide range of LTC financing issues and potential solutions.

Description: In this paper several probability models for the random amounts of needed long-term care are explained, and one model is used to provide an alternate premium calculation method for certain long-term care coverages. From Actuarial Research Clearing House 1990, VOL. 2.

Description: The SOA’s research objective is to provide guidance to state exchange officials and administrators, federal officials and administrators, and actuaries assisting states and health plans. The goal of the project is to estimate the morbidity and/or cost for newly insured individuals in the individual market (and to some degree, the small group exchange) relative to the morbidity and/or cost for the current commercially insured population. This analysis will primarily focus on the individual, non-group market. In order to plan for the impact that these currently uninsured individuals will have on the health insurance markets, it will be important to understand their costs relative to the costs for people already enrolled, for whom many health insurers have experience and data.

Description: PowerPoint slides of presentation given at Gerontological Society of America.