Description: As actuaries in health care, we spend most of our time focused on reviewing claims, enrollment and clinical data. That information is captured while patients are in health care facilities. Yet most people spend only a small fraction of their time in these facilities. This article explores what types of data are available to actuaries the provide a more holistic view of the member so that a members physical and emotional needs, the social determinants of health can be taken into consideration along with their clinical needs. Two uses cases are presented so actuaries can see how these types of analyses can be leveraged to improve clinical, operational, and financial performance of risk bearing health entities. Understanding the customer (member) not just the patient enables actuaries to provide new insights and values to our stakeholders across a wide range of business and risk applications.

Description: This paper describes the construction of the 1965 Supplementary Major Medical Tabular used to measure expect4ed claims. The paper also comments on the relationship of the intercompany 1963-65 experience to it. From Transactions of Society of Actuaries 1968, Vol. 20, Pt. 1, No. 56 AB.

Description: This paper presents a method for analyzing the experience of a stop-loss underwriter to develop a claim continuance table. This method is designed to deal with the limitations presented from certain limited information so as to get the most out of the available information. To the extent this approach is succesful, the credibility of the experience analysis will be maximized, thus minimizing the reliance on external data. From Actuarial Research Clearing House 1993, VOL. 3.

Description: This report describes the results of a survey on reflecting risk in pricing. The survey expands on one conducted in 2003 and was expanded to include life, health, P&C, and non-North American insurance companies.

Description: This session will explore the various methods of determining the credibility levels that are given to various size employer groups and Medicare plans. The background and theory of the methods that have commonly been used will be explained and then some new data-driven research in the area and possible alternatives will be discussed.

Description: This review summarizes the key features of a stochastic model that works with non-life insurance claim incurral, accrual and reporting. More specifically it provides an overview of the claim model components, classical parameter estimators, test statistics, and forecast point estimates and error variances. From Actuarial Research Clearing House 1991, VOL. 1.

Description: This study produces annual claim costs for Group Weekly Indemnity Insurance and Group Employee & Dependents Hospital & Surgical Expense Insurance and exhibits the trend in these claims costs. This report is based on a study by the Committee on Group Accident and Sickness Experience designed to satisfy that need to update previous studies due to the shift in emphasis by plan of benefit, the increase in level of hospital expenses and the change in pattern of these expenses. From Transactions of Society of Actuaries 1960, Vol. 12, No. 34.

Description: 1959 SOA Regional Meetings in Atlanta and San Francisco. These panel discussions reviewed procedures, techniques and vehicles used to provide benefits to retired employees. The panels also discussed Group Insurance Dividends and Major Medical issues.

Description: It is the purpose of this paper to provide data derived from actual claim experience on lives age 65 and over in a form that will facilitate actuarial calculations involving modification of durations of hospital stay and variations in the allowances provided for miscellaneous services billed by the hospital. From Transactions of Society of Actuaries 1963, Vol. 15, pt. 1, No. 43.

Description: This is the preface to the 1976 Report of The Committee on Group Life and Health Insurance. The report consists of the following sections: 1. Group Weekly Indemnity Insurance. 2. Group Long-Term Disability Insurance.