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: Uncertainty of a predictive model is a fact of life that many insurers could be overlooking at their peril without a framework for assessing it. The article provides a framework to understand the prediction uncertainty, which can be critical for the insurance operations using predictive models. Coin toss example explains model uncertainty and randomness inherent in making predictions to the number of heads expected. A mortality analysis case study illustrates how the Bayesian methodology can be used to develop the prediction uncertainty. In particular, the article shows that the Bayesian framework is a way to combine historical data and actuarial judgment, and directly address the model uncertainty through its posterior distribution.

Description: Regression to the mean is a phenomenon that arises when comparing sequential data points. It states that when an initial observation is extreme or an outlier, future observations will be closer to the average. Health care actuaries need to understand and be able to mitigate the effects of regression to the mean to avoid misapplying predictive models or misstating measurements of historical effects.