Description: The ACA’s Medical Loss Ratio Provisions

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: Collaborative filtering models drive recommendations provided by Netflix and Amazon. This article uses the same models to explore patients’ medical conditions.

Description: Article reviews the data a year into the unwinding of continuous coverage provisions in Medicaid, the impact on enrollment counts, how capitation rates have been adjusted, and compares those results to what has been modeled with the SOA Mediciad Unwinding model.

Description: A compilation of feedback from actuaries in the Health Section of the affects of the ACA.

Description: This article is about environmental risk occupations, local environment and substance abuse and how they influence actuarial financial estimates. From The Actuary Vol. 24, No. 1

Description: Analysis of the impact of disease progression and treatment on life expectancy provides perspective on the long term costs to the health care system of chronic medical conditions.

Description: Article Disparate Origins Of Life And Non-Life Insurances by Beard in The Actuary, February 1979, Volume 13, Number 2

Description: Affordable Care Act and Payment Reform

Description: This article shows how COVID-19 affected retirement risks, and how retirement planning was impacted by COVID-19. It ties together COVID-19 and its economic consequences with results of two recent consumer surveys that examine retirement risk perceptions and financial well being and a more complete discussion of retirement risks. The Managing Post-Retirement Risks guide divided retirement risks into economic risks, risks and personal planning considerations, and unexpected and unpredictable events. Each of the risks discussed in the guide is discussed in the article with commentary on COVID-19 and its impact, and information about how to manage the risk. For each risk, there is information provided about any insights gained in the two surveys. Results of the two surveys linked to COVID-19 are also discussed.