Description: This article discusses a study of the impact of the drug infliximab on Crohn's disease patients. This study had been approved in response to an SOA request for proposals for research on the health cost and utilization effects of a specific prescription drug.

Description: Explanation of Medicare Advantage STAR rating program as it relates to payment rates for MA bids. Also describes important features of the program from an actuarial perspective, how the components of the STAR rating are calculated and implications and considerations for actuaries.

Description: The Society of Actuaries to fund a research proposal to investigate risk adjusters.

Description: A closer look at family tier factor rating assumptions, and how well they reflect actual claim cost data.

Description: This article describes methodologies for detection and deterrence of Medicare fraud. It also describes the validation of PRIDIT for fraud detection in Medicare.

Description: This paper presents an approach to analyzing continuing care retirement community [CCRC] data, and demonstrates the methods using data from a large CCRC. It is assumed that residents make transitions among a number of states that represent the levels of care required by residents. There is randomness associated with both the transition times and the states entered at these times. The model is conveniently characterized in terms of transition intensity functions, which represent the instantaneous rates of transition between pairs of states.

Description: Panel discussion, by a physician and an actuary, about the historical forces behind various trends in organ transplant experience data.

Description: The purpose of this paper is to discuss the major health issues facing the United States of affordable care and cost controls. While this paper does not develop a specific health plan, it does analyze the problems and give direction. From Transactions of Society of Actuaries 1981, Vol. 33.

Description: Provides a summary of recent proposed regulations for the health insurer fee, section 9010 of the Affordable Care Act (ACA).

Description: This article will consider several issues arising from ACO budgeting and pricing of stoploss coverage, including: 1) attribution of members; 2) claim carve outs; 3) ambiguous stoploss terms; 4) providers gaming the system and 5) credibility of data.