Description: Changes introduced by various Medicare Alternative Payment Models and the Medicare Access and CHIP Reauthorization Act (MACRA) have accelerated an existing market trend of shifting some of what has traditionally been considered “insurance risk” to providers. The Provider Risk Sharing Boot Camp will give attendees deeper insights into methods, current thinking, and alternative solutions that actuaries can use to help providers understand and manage the financial and actuarial risks that they are taking, many for the first time.

Description: This paper explores the legislation of New York 65, the intent of which was to offer health benefits to persons age 65 and over without health examination or other evidence of insurability. From TRANSACTIONS OF SOCIETY OF ACTUARIES, 1962 VOL. 14, PT. 1 NO. 40.

Description: A research report that first defines ERM and provides the results of an applicable literature search with hyperlinks and then describes the current state of Enterprise Risk Management practices for health organizations. Areas covered: 1. Operational Risks. 2. Balance sheet risks. 3. Pricing discipline. 4. Asset risks. 5. Learnings. 6. Emerging risks.

Description: This discussion at the San Francisco 1966 Regional Meetings covers three topics - Disability Benefits under Life or Health Insurance Policies, Changes in Individual Medical Expense Insurance in the Light of Medicare, and Optional Modes of Settlement.

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: At this session of the 2004 Valuation Actuary Symposium, SEC medical rollforward schedules are reviewed. The background that led to these schedules, i.e. stock analysts attempting to understand earnings results, is presented. Differences in reserving practices among managed care companies are discussed.

Description: Through a case study, this session at the 2004 Valuation Actuary Symposium explores the issues e.g., grouping, expenses, time period, etc. involved in determining deficiencies reserves for health products. Accounting guidance and standard industry procedures are discussed.