Description: Presented at April 1986 Spring Meeting. This session discussion is about the impact of wellness programs on medical plan experience/non-medical plan experience, health status as a pricing variable, likely future developments.

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: 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: In this paper, fuzzy sets - collections of objects whose boundaries are not precisely defined - are used to model the selection process in group health insurance. Both single and multiple options plans are discussed. Discussions of this paper are included.

Description: This is a sequel to Panjer's paper. The Walter Reeed Staging Method - WRSM - is a method that groups patients infected with HIV into various stages. This paper looks at mathematically modeling the transition process of HIV by using the WRSM. This paper argues that Panjer's results are biased and understates the average time it will take an HIV life to develop AIDS.

Description: Presented at Living to 100 Symposium, January 2011. This paper addresses the question of how socioeconomic and demographic characteristics, health status and health behaviors are associated with oldest-old mortality and survivorship among people who have survived to old age. Data comes from the 1990-91 National Health Interview Survey’s Health Promotion and Disease Prevention Supplement and the mortality follow-up through 2002. The results indicate that activity limitation and exercise status, in combination with education, play an important role in survival into ages between 65 and 85, but have a smaller effect on survival among the oldest-old population of 85+.

Description: This section contains multiple book reviews and notices concerning the actuarial profession. Reviews: 'Medical Risks: Patterns of Mortality and Survival' by Singer and Levinson, 'The Theory and Practice of Pension Funding' by Trowbridge and Farr, 'Two Stochastic Processes' by Beekman, 'Disability Income Insurance - Cost Differentials between Men and Women' by New York Insurance Department, 'Social Security and Private Pension Plans: Competitive or Complementary' by McGill, 'A New Look at Accounting for Pension Costs' by Hall and Landsittel, '1977 Annual Reports of the Board of Trustees of the Federal OASDI Trust Funds...,' 'Investigation of Sickness Statistics - Individual Policies, 1971 and 1973' by the Institute of Actuaries and the Faculty of Actuaries, 'The Graduation of Pensioners and of Annuitants Mortality Experience 1967-70' by the Institute of Actuaries and the Faculty of Actuaries, 'Pensions and Survival - the Coming Crisis of Money and Retirement' by Calvert, 'Group Benefits in a Changing Society' by Spencer, 'Experience of Disabled Work Benefits under OASDI 1965-74' by Bayo and Wilkin. Digests also included.

Description: Presented at Living to 100 Symposium, January 2011. This article estimates the impact of obesity and diabetes on disability and mortality for those older than 65 using the 2004 National Long Term Care Survey with disability based on the Health Insurance Accountability and Portability Act's Activities of Daily Living and Cognitive Impairment triggers.

Description: This session is about health risk adjusters and includes a discussion on risk assessment, actuarial applications, New York small-group reform, medical management applications, Rand 36, and other methods. From Record of Society of Actuaries Vol. 19, No. 4B.

Description: Presented at Living to 100 symposium, January 2011. This paper investigates dynamic properties of age trajectories of physiological indices and their effects on mortality risk and longevity using longitudinal data on more than 5,000 individuals collected in biannual examinations of the Framingham Heart Study original age group during about 50 subsequent years of follow up.