Description: A look at the near future and far future of various elements of Actuarial Models as defined through ASOP 51. What is driving the complexity for inputs, calculations, and outputs. Howe will actuaries handle these challenge?

Description: Actuaries have the business acumen, problem-solving capabilities, and technical skills to develop innovative and data-driven solutions in the social insurance space. It is time we expand our scope and embrace an increased role in making a positive impact within the health care ecosystem. The primary focus of this paper is on social insurance programs dedicated to the most vulnerable population: low-income families accessing care through Medicaid. While there are numerous challenges that require other subject matter experts to take the lead, this article highlights topics where actuaries can be key players in developing and implementing tangible solutions to improve the care for the most vulnerable. Issues and solutions in this paper focus on the following three areas: 1. Access to appropriate care, 2. continuity of care, and 3. social determinants of health.

Description: Congress authorized the creation of the RAISE Family Caregiving Advisory Council in 2018. The Council, comprised of family caregivers and experts from a wide variety of stakeholder organizations in both the private and public sector, have been engaged in an in-depth research effort over the last two years to develop recommendations and an implementation plan to address our national caregiving crisis. This article describes their work and the newly released Report to Congress.

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: Introduce basic concepts of the Health Risk-Based Capital and show case a few strategies around Risk-Based Capital.

Description: To inform and educate stakeholders for health plans and insurers on novel ways to optimize reinsurance structures to meet capital related goals and boost RBC and liquidity ratios. In lieu of traditional market-based financial instruments involving equity and/or debt, a quota share transaction can be used with potentially far more attractive terms and achieving essentially the same result.

Description: ACA risk adjustment is intended to "bridge the gap" between allowed rates and actuarial rates. If risk adjustment methodology is not bridging that gap & becomes an additional input to pricing formulae, it is not serving its intended purpose.

Description: COVID19 highlights the need for greater complexity expertise in risk management. Crisis like the current COVID19 pandemic and 2008 Financial meltdown and others help us to turn into focus inwards for introspection on how we can better manage our resources and provide a deeper understanding of what our objectives should be and how we can achieve them through applying complexity science.

Description: Critical illness insurance is a popular supplemental health insurance product in the U.S. market. This article discusses how carriers have recently sought to add value by expanded the benefits offered in their critical illness products. Specifically, the article discusses the consumer need and development considerations of adding benefits for autism Spectrum Disorder, Mental health disorders, Specified Disease Coverage, and enhance Cancer Coverage to a critical illness contract.

Description: Milliman surveyed carriers about their recent LTC rate increase experiences. A total of 20 companies participated in the survey, representing 65 percent of LTC premium in the United States. This article highlights some of the findings from this survey, along with additional considerations when pursuing LTC rate increases.