Description: Panelists discuss the methods HMOs employ to measure their providers' quality of care, outcomes, compliance with best practice guidelines, and cost control. From the Record of the Society of Actuaries, Vol. 25, No. 2.

Description: Regression to the mean is a phenomenon that arises when comparing sequential data points. It states that when an initial observation is extreme or an outlier, future observations will be closer to the average. Health care actuaries need to understand and be able to mitigate the effects of regression to the mean to avoid misapplying predictive models or misstating measurements of historical effects.

Description: Description of the vast variety of predictive analytics topics covered by the Forecasting & Futurism section and introduction to the July 2015 issue of the newsletter.

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: Health Watch, Issue 79, December 2015, Health Watch

Description: This chapter focuses on creating practical models that aid in the prediction of the risk of readmission to a specific hospital within 30 days of discharge for Medicare patients, to aid in the identification and stratification of at-risk patients for hospitals considering building an intervention program in a cost-effective manner. For readers who wish to develop their own predictive model, a dataset is provided on the Actexmadriver.com website, and R code is provided in the appendix to this chapter.

Description: In this paper, we illustrate how to value American-style options using the Least-Squares Monte Carlo LSM approach proposed by Longstaff and Schwartz 2001 and investigate whether there exists an optimal regression complexity in the LSM framework for options pricing. In particular, we use the smoothing spline in the regression step, which allows us to control the regression complexity on a continuous scale with just one tuning parameter. Numerical results on American put options indicate that we need to use more than a linear regression, but as the regression becomes more complex, the accuracy of the LSM method quickly deteriorates. From 39th Actuarial Research Conference.

Description: While many know that machine learning is a big deal and even have a general idea of what it is, many do not know what machine learning can do for them. As an alternative to citing achievements or explaining algorithms, this article outlines the challenges that occur in statistics and the solutions that machine learning offers. Some of those challenges include correlated predictors, missing data, data interaction, and prediction intervals. Corresponding solutions include regularization technics, missing value imputation with KNN, tree based models, and cluster analysis for backtesting.

Description: The Johns Hopkins ACG Team's comments regarding their participation in the Comparative Analysis of Claims-Based Tools for Health Risk Assessment.

Description: Second article in a series on how to use predictive analytics to improve the development of long-term care projection assumptions.