Description: This is a brief report that summarizes recent changes in the prevalent medical loss ratio methodologies and also looks at some of the more recent experience of health insurers that filed medical loss ratio reports.

Description: Supporting Excel file for Getzen Model 2022.

Description: Supplemental Appendices for Using Social Determinants to Identify Profiles of U.S. Children with Low Dental Expenditures and High Medical Expenditures with Clusters

Description: Technical report to accompany Fifty States, Fifty Stories: A Decade of Health Care Reform Under the Affordable Care Act.

Description: Healthcare costs have been rising faster than general inflation for many years. Early models that predicted this past pattern projected healthcare expenditure growth that continued to outpace total expenditure growth leading to the fallacious position that the whole of the US economy would ultimately be consumed by healthcare. This paper presents a long term healthcare trends resource model, prepared for the Society of Actuaries by Professor Thomas Getzen, that includes capacity constraints to ensure the long-term projection is rational. The motivation for creation of the model was driven by its potential usage as a resource for the estimation of reportable liabilities for retiree healthcare benefits as specified under FAS 106 and GASB 45 accounting statements.

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: Tree models have been found to provide a good fit to group long term disability recovery and mortality rates. This research paper provides an overview of tree models, and details how they have been used for developing these rates.

Description: The Health Plan Employee Data and Information Set 'HEDIS' is a set of standardized performance measures initially designed to enable purchasers of health care to evaluate and compare a managed care plan’s administrative performance. The National Committee for Quality Assurance, known as the NCQA, developed HEDIS in 1991. Since its introduction, HEDIS has become a widely used tool for measuring a broad array of health plan functions. This study evaluates the reliability and validity of HEDIS measures. It also reviews the usefulness of HEDIS as an indicator of health care quality.

Description: Analysis of possible mathematical relationships between hospital quality and hospital billed or allowed charges or other measures, using quality data as defined by the U.S. Department of Health and Human Services along with the Hospital Quality Alliance for their Hospital Quality Initiative.

Description: The actuarial committee that authored this report developed a model to estimate the revenue the tax would generate. The results point out key considerations for an excise tax on high cost health plans, including the wide range of results generated by sensitivity to certain assumptions.