Description: The Health Care Cost Institute (HCCI) recently released their annual health care cost and utilization report on February 13, 2020. This report illustrates employer group commercial health care costs and trends from 2014 – 2018.

Description: Through the sponsorship of the Robert Wood Johnson Foundation, The Society of Actuaries partnered with Wakely to use their health care data to study the effects of COVID-19 on overall health care claims for individuals with a COVID-19 diagnosis. The conclusion of the study is that individuals with COVID-19 claims had significant increases in health care costs leading up to their months of diagnosis, as well as in the months following their diagnosis. These effects were more pronounced for individuals who were hospitalized due to COVID-19 as well as for individuals with prior co-morbidities. Finally, the overall health care costs of these members plateaued at significantly higher levels than their pre-COVID baselines. In fact, all the main membership cohorts experienced claim levels that were at least 20% higher than their pre-COVID starting points.

Description: In preparing claims reserves in the annual statement, health insurers and their opining actuaries will generally include a provision for adverse deviation (PAD) in their reserved amount in order to satisfy language in both in the National Association of Insurance Commissioners (NAIC) Health Annual Statement Instructions and in Actuarial Standards of Practice. This article explores the total level of PAD (both implicit and explicit margin combined) included in the reported claims reserves by examining NAIC filing data from 2016 through 2022.

Description: This Society of Actuaries Research Brief has been constructed to highlight some of the key features of the pandemic and contemplate the risks for the actuarial profession to consider in their work.

Description: The US healthcare system is among the world's most advanced, but is the highest-cost by far. At Swiss Re we studied the highest-cost US Medicare beneficiaries during 2016. The Medicare government program primarily covers seniors and individuals with disabilities. Total Medicare spending during 2016 was nearly USD 700,000,000,000. In our study, the 1% of beneficiaries with costs of USD 125,000 or higher generated 15% of total claim costs. Better understanding of these beneficiaries and their treatment could lead to improved quality and efficiency of care. Analysis of their claims can aid projections of the expected level and variance of costs. We calculated claim costs and rates, and identified higher-cost segments (including inpatient claims, individuals with disabilities or end-stage renal disease, Pacific states including California, and men). We look forward to expanding the analysis in future updates.

Description: The Health Care Cost Institute (HCCI) recently released their annual health care cost and utilization report on February 13, 2020. This report illustrates employer group commercial health care costs and trends from 2014 – 2018.

Description: Health brief on impact of COVID-19 cost to health insurers.

Description: This Society of Actuaries Research Brief has been constructed to highlight some of the key features of the pandemic and contemplate the risks for the actuarial profession to consider in their work.

Description: Health brief on impact of COVID-19 cost to health insurers.

Description: Health claims are not normally distributed. Claims Forecasting can be improved by understanding the entire distribution of plausible values of future claims, for example knowing there is an 80% chance future claims are between $340 and $375 PMPM. Confidence intervals around our estimates allow us to understand for each range around the best estimate (for example +/- 1%) what is the probability that future claims will fall in that range. Quantile Regression is a mathematical technique where you can estimate any percentile of the claims distribution you are looking for as a function of demographics, diagnosis indicators, prior cost variables, or other significant predictors. You can see which coefficients are important at different parts of the distribution. Individual and group distributions can be constructed. There are numerous applications in pricing and underwriting, stop loss, provider profiling, ACO target setting, allocation of group risk charges based on volatility, discounting strategy, and experience analysis.