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: This is an Excel workbook that can be used as a tool for health insurance companies to model their potential risk exposure from an influenza pandemic. It is based on a model developed for a Society of Actuaries study examining the potential implications of a pandemic on the U.S. health insurance industry. The spreadsheet is saved with many of the same assumptions used in this research and reproduces the results of the exhibits contained in the June 2010 report, 'Potential Impact of Pandemic Influenza on the U.S. Health Insurance Industry.'

Description: Since the outbreak began in January, numerous research groups throughout the world have developed models to forecast the number of deaths that could result from COVID-19. Updated April 24, 2020.

Description: This tool created graphs of Google's mobility Data. This version of the tool contains global, country-level data through July 31, 2020

Description: Article discussing how the pursuit of value-based care as a consequence of health care reform laws such as the Affordable Care Act (ACA) and the Medicare Modernization Act has accelerated the use of risk adjustment and what it means to actuaries.

Description: The report looks at the different outcomes for the 50 states from the ACA, in terms of cost and availability of health insurance coverage. It identifies 11 key observations since the passage of the ACA.

Description: In the past months, as COVID-19 has forced the reduced activity in the U.S. economy there has been some very substantial, but varied effects on the U.S. healthcare system. There is a lot of potential for confusion amongst providers and patients with regards to decisions related to which services ought to be rendered and which ought to be deferred. Two specific agencies – the Centers for Medicare and Medicaid Services (CMS), and the American College of Surgeons (ACS) have put together some guidance to add more clarity towards what types of services should be provided and what types ought to be deferred. In addition, this paper includes a discussion on what types of services are most likely to be deferred, and which ones will accrue pent-up demand to be released when many of the deferred services become available again.

Description: Social Determinants of Health (SDOH) include the social and physical conditions in which people are born, live and work on a daily basis. This project advances a growing body of literature to inform the ongoing optimization of population health and payment models.

Description: The SOA has translated four of its AIT report summaries into both Traditional and Simplified Chinese. They are “Behavioral Science”, “Big Data and the Future Actuary”, “Cancer Genomics”, and “Cloud Computing and Machine Learning Uses in the Actuarial Profession.

Description: The US healthcare system is among the world's most advanced, but is the highest-cost by far. At Swiss Re we studied the highest-cost US Medicare beneficiaries during 2016. The Medicare government program primarily covers seniors and individuals with disabilities. Total Medicare spending during 2016 was nearly USD 700,000,000,000. In our study, the 1% of beneficiaries with costs of USD 125,000 or higher generated 15% of total claim costs. Better understanding of these beneficiaries and their treatment could lead to improved quality and efficiency of care. Analysis of their claims can aid projections of the expected level and variance of costs. We calculated claim costs and rates, and identified higher-cost segments (including inpatient claims, individuals with disabilities or end-stage renal disease, Pacific states including California, and men). We look forward to expanding the analysis in future updates.