Description: View the following report regarding Risk Scoring in Health Insurance: A Primer.

Description: The purpose of this study is to evaluate the predictive accuracy of the commercially available claims-based risk assessment tools under different sets of conditions and with different sets of available information.

Description: This report aims to expand our understanding by providing a methodology to quantify uncertainty in risk assessment.

Description: This report summarizes the key findings and data points from the selected articles. Included for each article are the report’s abstract along with any empirical data available from the study that can help support an actuarial model that identifies the relationship between lifestyle behaviors, health risk conditions and health outcomes.

Description: This document provides key findings from the 2007 Risks and Process of Retirement Survey related to health and long-term care risks in retirement.

Description: This is a final report to help individual health plans evaluate and manage their potential exposure during a specific pandemic. It examines the potential impact of pandemic influenza on different payers in the U.S. health care system.

Description: In this, the second step, Sibson engaged the vendor and actuarial communities to solicit input on the actuarial model for determining the impact of various environmental, lifestyle and behavioral risk factors. The goal was to understand the extent to which actuaries currently use models around wellness, refine the above conceptual model, and better understand the potential uses of, and value to, the actuarial and vendor communities that would use such a model. We sought to understand the potential applications and sources of data for the actuarial model. We gathered input on how the model would best suit the professional needs and help shape the future role of the actuary. Lastly, we gathered feedback on the above conceptual 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 paper highlights the menace of overweight and obesity which are on the rise. Health care systems and insurance industries are directly affected. Liability claims are on waiting. The food related damage claims are costly. Insurers are therefore driven to find a solution: classify overweight and obesity as a group, adjust their premium to reflect the cost, and justify the classification and the adjustments.

Description: This study aims to answer the question of how much of an episode’s cost and use of specific services can be attributed to the patient’s own health status, as opposed to being driven by other factors such as the care setting, patient preference, and provider practice patterns. In other words, do episode costs vary so widely because of patient characteristics, including health status, or are they related to other, nonclinical factors?