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: Slides from a panel discussion session at the Spring meeting of the Society of Actuaries held in San Antonio, Texas, June 14-15, 2004 Discussion of the basics of actuarial appraisals: Panelists discussed the reasons to perform an actuarial appraisal, the processes involved, issues that should be addressed and assumption development.

Description: Regression to the mean (RTTM) is inflating your health care intervention evaluations if you are not carefully managing it's omnipresent and significant impact RTTM is the statistical phenomenon which arises when comparing sequential data points when an initial observation is extreme or an outlier, and states that with no other intervention, future observations will be closer to the average. Members who had high costs last year will, on average, have lower costs this year, even in the absence of any intervention or clinical program, simply by 'regressing' to the mean. This means that if your clinical programs are simply targeting members who had adverse medical experience last year, you’re targeting the wrong people. And if your savings methodologies are simply last year’s costs minus this year’s costs, the savings are inflated. By attending this session, you will be able to identify situations where RTTM will be a significant factor, how to eliminate it's impact when performing retrospective evaluations, how to identify prospects for clinical intervention with RTTM in mind, and more.

Description: This paper describes risk-factor-dependent multiple decrements and actuarial cost functions as a general compartment model, a discrete time and discrete state stochastic model of morbidity and mortality processes. For large numbers of risk factors, the model is extended to its natural continuous time and state form. From Transactions of Society of Actuaries 1991, Vol. 43.

Description: This report provides a toolkit for actuaries and other interested parties to model and forecast mortality by cause and socioeconomic factors.

Description: Read the December 2016 issue of The Modeling Platform published by the Modeling Section. Newsletters provide practical information for the working actuary, articles on trends that impact sections and news about section activities.

Description: "Hear AM Best rating analysts discuss the rating process and the best capital adequacy ratio (BCAR), a quantitative foundation for AM Best’s assessment of carriers’ financial strength. The benchmarking of BCAR scores for various company types (national MCOs, BCBS plans, smaller regional plans) will be discussed. Look at how changes in investment and underwriting environment impacted the results over the past several years. Further, AM Best’s view of the quality of capital and various factors impacting the overall assessment of the balance sheet strength will be discussed. By attending this session, you will: Gain an understanding of AM Best’s building block approach to ratings and how the BCAR results fit into the process. Learn the differences between RBC and BCAR models. Learn how various factors—e.g. liquidity, financial flexibility, financial leverage, the org structure—impact the final AM Best assessment of health companies' capital."

Description: Recent research from Financial Finesse introduces a viable way to forecast the potential return on investment (ROI) of workplace financial wellness programs.

Description: This session from the 1993 Valuation Actuary Symposium focuses on problems and solutions observed by consulting firms including cash flow testing, modeling of assets and liabilities, who the valuation actuary relies upon and the software being used for valuation actuary work.