Description: A health actuary describes her journey as a parent of a child with medical needs, and the complexities associated with navigating the health insurance industry.

Description: Obesity rates in the United States have climbed to historic highs, with nearly 42% of adults now classified as obese—a trend with significant implications for the health care system. Among Medicare-aged individuals, obesity is strongly associated with chronic conditions such as diabetes, cardiovascular disease and musculoskeletal disorders, all of which increase health care utilization and spending. As costs continue to rise, understanding the financial impact of obesity management is increasingly important for policymakers, payers and providers. This analysis uses detailed traditional Medicare claims and eligibility data to examine how obesity levels relate to health care expenditures and how costs change as members move between different diagnosed obesity categories over time

Description: Yi-Ling Lin, FSA, MAAA, FCA, started the SOA’s Predictive Analytics Certificate Program to keep pace with the impact big data and predictive modeling is having on the health care industry

Description: The presenters will focus on best practices in drug claim management in North America. The presentation is geared toward Canadian practice and insights, but is useful for practitioners in the U.S. and elsewhere, as well.

Description: A study of disability experience examines cost burden and degree of disability, and how these measures vary across different subpopulations.

Description: Discussion of the separate and joint effects of obesity and diabetes on disability and mortality, and ways these effects can be used to improved insurance pricing and reserving, reverse the increasing rates of obesity and diabetes, and improve current projections of disability and mortality risks.

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 is the abstract to the paper, A Comparative Analysis of Chronic and Non-Chronic Insured Commercial Member Cost Trends.

Description: Discussion of “Health Expectancy” paper and reply from author, Faye Albert. Discussion of Human Behavior: An Impediment to Future Mortality and Discussion of Health, Wealth and Wisdom - Living Long, Living Well: An Actuary Muses on Longevity

Description: The coming wave of biosimilars could dramatically affect prescription drug costs and benefit strategies over the next several years. The launch of many Humira biosimilars in 2023 is the Big Event that will largely determine the impact of the biosimilar wave. Payers have many decisions to make about coverage and formulary tiers. What factors will drive payer decision-making?