Description: Article describes enhanced primary care models and provides citations on whether or not health care savings have been achieved.

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: This session is about rationing health care. From Record of Society of Actuaries Vol. 18, No. 4A.

Description: A dicussion of the Rate Classification Actuarial Standard of Practice, ASOP #12: its purpose, its scope, guidance, and examples.

Description: Managed Care Risk-Based Capital new formula for HMOs and BCBS plans, modification of disability income, LTC and stop loss factors, market uses of RBC, company use of RBC Issue No. 37.

Description: On January 1, 2014, many states will be enrolling newly eligible parents and childless adults into the Medicaid program. This article compares the expansion population to the current Medicaid population.

Description: This article contains a condensed summary and excerpt from the fourth white paper in the Commercial Health Care: What’s Next? series.

Description: Health care predictive analytics varies between payers and providers as well as being a powerful tool in business decision modeling.

Description: Essential Health Benefits and Actuarial Value

Description: Affordable Care Act and Payment Reform