Description: Learn about key actuarial and analytic tools and methodologies used by commercial health insurance to identify and quantify drivers of healthcare cost and utilization (including wasteful and low-value ones) and risks. Use case scenarios in which these tools and methodologies apply, such as underwriting, reinsurance, medical management for population health and chronic diseases, managed care contracting, insurance market reform, provider payment reform, etc., will also be covered. Experience from the U.S., China and other parts of the world will be shared.

Description: This research project offers guidance and a model for actuaries to use when performing their professional services related to Medicaid (Title XIX) and Children’s Health Insurance Program (CHIP or Title XXI) managed care capitation rate setting, including, but not limited to, their certification on behalf of a state in accordance with the requirements for actuarial soundness as set forth in law, federal regulation, and CMS guidance, as well as the actuary’s professional obligations under the Actuarial Standard of Practice (ASOP) 49 issued by the Actuarial Standards Board.

Description: On March 22, 2022, the Wall Street Journal hosted its annual Health Forum, a virtual all-day event which included several sessions. This session was attended by experts across the healthcare space and attendees included many from the healthcare technology companies. This report summarizes the event.

Description: A study of whether tobacco, area and industry rating in one state may be reflecting unintended factors such as race, ethnicity or socioeconomic status. This study does not consider whether the rating factors accurately reflect underlying claims costs.

Description: This is an abstract for the paper, Analysis of Costs for a Chronic Disease with Acute High Cost Episodes by Marjorie Rosenberg and Philip Farrell.

Description: This paper is being produced in conjunction with eight companion pieces reflecting a variety of stakeholder experiences with the development of the risk pool.

Description: This is the Introductory Study Note for the Society of Actuaries Group and Health-Company/Sponsor Perspective examination for Spring 2012 that will be given on Friday, April 27th, from 8:30 a.m. – 11:45 a.m. and 1:30 p.m. – 4:45 p.m.

Description: The Society of Actuaries' Pension Section and Health Section Research teams commissioned Professor Thomas E. Getzen of Temple University to construct a resource model for the projection of long term healthcare cost trends. The motivation for creation of the model was driven by its potential usage as a resource for the estimation of reportable liabilities for retiree healthcare benefits as specified under FAS 106 and GASB 45 accounting statements. This model, programmed in Microsoft Excel [xlsx format], projects per-person expenditures and growth rates through 2099 using a set of equations and assumptions developed by Professor Getzen with assistance from the Society of Actuaries Project Oversight Group appointed to oversee the effort. The model includes baseline assumptions as well as flexibility for user–inputted alternative assumptions.

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.