Description: Traditional risk scoring models include only fixed (non-random) demographic and condition-based variables. By including the provider effect as part of the risk scoring model as a random effect, we can get better estimates of provider performance (incorporating practice patterns conditional on patient morbidity profile). This approach can be generalized to study other factors that are now masked in error variance (i.e. area, Social Determinants) but if modeled could give us better estimates of risk

Description: The method in this paper is to derive expressions for mortality between integral values of age underlying the typical approximations employed, and to compare such expressions. Annuity and life reserve formulas are compared. Discussions of the paper are included.

Description: There are three commonly used methods for compiling exposure and death data for use in obtaining crude mortality rates. They are lives, policies and amounts of insurance. This paper investigates the properties of estimators based on lives, amounts and robust alternatives. It is concluded that lives provide the best estimator, even when there is a moderate dependence of mortality rates on amounts of insurance. Presented at the Fourteenth Actuarial Research Conference, lowa City, lowa, September 6, 1979.

Description: This is a presentation From 38th Annual Actuarial Research Conference 8/9/2003, University of Michigan, Ann Arbor, Michigan. Pricing health insurance presents numerous statistical problems. This paper develops a non-parametric method for handling these problems. This method involves kernel density estimation of the charge level distribution and also kernel smoothing between the reimbursement function derivatives. It derives some properties of the estimates so obtained. It illustrates the method with some dental data and compares the results to some other simpler estimation techniques.

Description: Users of statistical packages should be more aware of the influence that outlying data points can have on their statistical analyses. Robust procedures provide formal methods to spot these outliers and reduce their influence. While a few robust procedures are mentioned in this article, one is emphasized and it is motivated by maximum likelihood estimation to make it seem more natural. In this article, the author will try to provide some background, beginning with maximum likelihood estimation of one parameter, that will hopefully make robust estimation seem natural and rather easy.

Description: The theory underlying the Moving Weighted Average graduation method is restated in the language of linear algebra which provides for an enrichment of the family of formulas. A comparison of the results of applying six members of the family to 100 simulated data sets is provided.

Description: In this continuation of our July 2013 article we explore an algorithm for evaluating Hidden Markov Models in detail. A preferred method in speech recognition technology, Hidden Markov Models are a promising technique when dealing with data you suspect may be driven by a change in a unobservable state. The example in the article is provided in an Excel workbook for the reader to follow along with.

Description: A guide to the protocols and rules necessary to ensure an accurate savings comparison when using an historical claims repricing in the PBM RFP process.

Description: Recognizing an opportunity to help serve its members in this age of increased financial oversight, the Health Section of the Society of Actuaries commissioned a series of guides on the use of statistical techniques specifically geared for the work of health actuaries. In this first guide in the series, the topic is an estimate well-known to health actuaries- the calculation of incurred but not reported [IBNR] health claims reserves. In particular, this guide focuses on the development of confidence intervals around IBNR estimates.