Description: Identifying and submitting all appropriate ICD-9 diagnosis codes to CMS will result in a higher risk score for the member and increased payments to Medicare Advantage plans. Milliman's HCC prevalence study illustrates the significant variations in HCC prevalence rates by age/gender, geography, and population type and will assist plans in benchmarking the effectiveness of their own diagnosis code capture efforts.

Description: Hybrids of the soft computing SC technologies have been applied to market forecasting and trading rules, and in many cases have demonstrated better performance than competing approaches. The purpose of this research is to investigate a representative group of these applications and to document the manner in which hybrids of the SC technologies were implemented.

Description: The author recounts his experience as a keynote speaker at the Actuarial Research Conference and provides advice to young actuaries to present complex subjects in an understandable manner.

Description: Explores the open vs. closed systems debate with regards to actuarial modeling and exposes the over-simplification. Valuable for anyone who uses models.

Description: This article introduces SymPy, a computer algebra system (CAS) for the Python programming language.

Description: A new health insurance pricing model takes external market prices into account, as well as regulatory rate restrictions and other traditional pricing factors. Rather than being assumed at the outset, lapse rates emerge from the model, along with assessment spiral & loss ratio projections. Under the model optimal pricing strategy depends on whether the class being rated has a healthier than average mix of risks.

Description: Although rate structures where low-cost cohorts subsidize high cost cohorts may be justified from a actuarial, marketing, or legal standpoint, the subsidization creates risks which must be understood and monitored. This article presents the concept of subsidization signature to measure and interpret the effects of rate subsidization, and to assess the sustainability of rating structures and the sensitivity of business mix assumptions.

Description: A discussion of permissible use and collection of genetic information for Health Risk Assessments and wellness programs under the Genetic Information Nondiscrimination Act of 2008.

Description: A closer look at family tier factor rating assumptions, and how well they reflect actual claim cost data.

Description: By disinformation we mean the inclusion of data that should not be considered in a study. In this paper we discuss a case in which the presence of disinformation was clear, but it was not possible to determine with certainly which records were extraneous.