Description: This paper applies the principles and methodologies discussed in earlier papers in this series to measure cost savings from a two-year disease management DM program for the 200,000 Medicare members of a regional managed care plan. We then study how savings estimates change when we allow for four variations in key assumptions: methods for identifying or excluding plan members, requirements for eligibility in the health plan, methods for calculating health care trend and study design. Finally, we also examine the sensitivity of these results to product type by comparing the Medicare results to those of the Commercial HMO/POS product. Paper 8 of an 8 paper series titled: “Evaluating the Results of Care Management Interventions: Comparative Analysis of Different Outcomes Measures” sponsored by the Society of Actuaries’ Health Section and the Committee on Knowledge Extension Research.

Description: This article describes methodologies for detection and deterrence of Medicare fraud. It also describes the validation of PRIDIT for fraud detection in Medicare.

Description: Defines Accelerated Underwriting programs as a transformational trend, and outlines a process for evaluating mortality implications of such programs.

Description: The next evolution of actuarial systems in the U.S. will likely be a move toward a single system solution. This article defines a single system solution and illustrates how models can be shared across actuarial functions, the potential benefits of a single system solution, and describes potential mitigation strategies to address typical actuarial concerns.

Description: In physics and engineering education, Fermi problems require solutions based on good approximate calculations with little or no actual data, involving making justified guesses and deducing bounds without using sophisticated tools. The idea of Fermi problems are of particular relevance to today's actuaries, as pricing, reserving, and financial reporting involve more and more complex stochastic components. The paper discusses some approximate solutions developed in academia in the spirit of Fermi problems.

Description: On October 30, 2015, the SOA Assumption Development and Governance Group, an informal discussion group consisting of nearly 200 interested actuaries with topics pertaining to actuarial assumption development and governance, organized an industry discussion call on end-to-end assumption documentation practices. The purpose of this call was to generate a large list of ideas for best-practice assumption documentation. More than thirty companies were represented in the call, including direct insurers, reinsurers and consulting firms. This article is the work product of the discussion written by Laurie Li and Alex Zaidlin.

Description: This article describes some of the drawbacks to the assessment of longevity risk adopted by most practitioners within the UK together with an initiative that provides a platform for an alternative approach that is both (a) more forward-looking in nature and (b) can complement current practices.

Description: Details of an actuary’s project to help a local nonprofit agency improve its data analysis and customer service issues.

Description: This newsletter column by the Modeling Section Chair reflects on his attendance at the 2015 Actuarial Research Conference in Toronto and the relationships between practicing actuaries in industry and those in academia, and specifically those involved in research. How can we help promote academics research that is effective and relevant for practical use? Hopefully the Modeling Section might facilitate that effort.