Description: As part of the SOA’s July 22, 2020, COVID-19 Virtual Symposium, Marketing and Distribution (MaD) Section Council members presented “Selling Insurance Six Feet Apart” with insight into emerging sales and marketing processes, challenges, and opportunities for the product spaces noted

Description: There are early indications of a six year cycle in ACA markets reminiscent of the traditional underwriting cycle.

Description: The article describes the insurance industry's preparation for pandemic events and the public finance response.

Description: This article explores the disruptive applications of blockchain, an emerging technology, and its impact on the pharmacy benefit space, and pharmacy benefit managers (PBM).

Description: The diary of Dirk Nieder, an actuary who traveled in Asia amid the COVID-19 pandemic, tying in what he saw in asia countries and developments from the west.

Description: The article provides insights about the need for revolutionary actuaries in Saudi Arabia due to the reform that is happening across the kingdom under all sectors. Then I talk briefly about the health sector and the transformation that is happing in the sector, and how qualified health actuaries can contribute to this health reform.

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.

Description: Article discussing how the pursuit of value-based care as a consequence of health care reform laws such as the Affordable Care Act (ACA) and the Medicare Modernization Act has accelerated the use of risk adjustment and what it means to actuaries.

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: Health insurance company assets and liabilities have evolved since the Patient Protection and Affordable Care Act (ACA) was signed into law in March 2010. The ACA fundamentally rearranged how commercial health insurance is funded by integrating federal premium subsidies and pass-throughs together with a marketplace interwoven with transfer payments among stakeholders. The impacts of these programs can be seen in specific accounting items on the balance sheets of health insurance companies over the past 10 years. Their emergence follows three primary trends: (1) balance sheet items tend to be larger and take longer to settle, (2) there are more interactions among items, and (3) the final settlement amounts are more uncertain.