Description: Profile of an actuary in a non-traditional actuarial role: focusing on medical cost and analysis, both retrospective and prospective.

Description: According to the Actuarial Standards Board’s Actuarial Standard of Practice No. 49 (ASOP 49), actuarially sound Medicaid managed care capitation rates will include a provision for underwriting gain in order to provide compensation for the risks assumed by an MCO. However, there is no generally accepted method for quantifying underwriting gain in managed Medicaid capitation rates. This article discusses a new model developed to address this void and calculate underwriting gain. The model was developed by researching existing financial literature and performing a statistical analysis of industry data to build out a framework that can be leveraged to estimate underwriting gain.

Description: In this article, the author discusses the considerations and advantages of implementing an integrated enterprise risk management program for a health insurance company, and presents a summary of Aetna's experience with ERM as a case study.