Description: A detailed look at charges to the FSA pathway in the GI track that is planned for 2023.

Description: ACA risk adjustment is intended to "bridge the gap" between allowed rates and actuarial rates. If risk adjustment methodology is not bridging that gap & becomes an additional input to pricing formulae, it is not serving its intended purpose.

Description: An update to the risk management readers on what the JRMS is planning to do over 2023 to serve its membership.

Description: Significant progress has been made in transforming the actuarial profession but it remains untransformed. Universities have been instrumental in training future actuaries and this article is about how the University of Cape Town has been addressing transformation in the actuarial program. The school system in South Africa has struggled to produce the required quality and quantity of school leavers prepared for higher education. This has led to universities having to develop ways to manage this problem. The article discusses the effectiveness of some of the initiatives introduced at UCT.

Description: Centers for Medicare & Medicaid Services (CMS) launched the GUIDE model, which represents a significant step forward in improving dementia care nationwide. Those with deep expertise in dementia recognize that family caregivers are the most powerful frontline defense to improve care for people living with dementia. It is thus not surprising that the GUIDE model specifically requires the inclusion of the family caregiver in the care team.

Description: Technology now supports customized non-level death benefits which help consumers optimize their coverage and cost. Creating individual policies and individually pricing them for a level premium quote is the start of personalizing and optimizing coverage and cost for consumers and pricing life insurance policies at the individual consumer level --- a revolution for actuaries.

Description: A brief overview of last year's Education & Research Section Council work, accomplishments and challenges from its outgoing chair.

Description: As actuaries in health care, we spend most of our time focused on reviewing claims, enrollment and clinical data. That information is captured while patients are in health care facilities. Yet most people spend only a small fraction of their time in these facilities. This article explores what types of data are available to actuaries the provide a more holistic view of the member so that a members physical and emotional needs, the social determinants of health can be taken into consideration along with their clinical needs. Two uses cases are presented so actuaries can see how these types of analyses can be leveraged to improve clinical, operational, and financial performance of risk bearing health entities. Understanding the customer (member) not just the patient enables actuaries to provide new insights and values to our stakeholders across a wide range of business and risk applications.

Description: Lifetime pension pools convert a lump sum into lifelong income, periodically adjusting benefit payouts based on mortality and investment experience. Volatility-targeting strategies can enhance benefit stability by dynamically adjusting the investment portfolio’s exposure to risky assets in the context of these pools, demonstrating superior performance compared to traditional static asset allocation methods.

Description: Actuaries have the business acumen, problem-solving capabilities, and technical skills to develop innovative and data-driven solutions in the social insurance space. It is time we expand our scope and embrace an increased role in making a positive impact within the health care ecosystem. The primary focus of this paper is on social insurance programs dedicated to the most vulnerable population: low-income families accessing care through Medicaid. While there are numerous challenges that require other subject matter experts to take the lead, this article highlights topics where actuaries can be key players in developing and implementing tangible solutions to improve the care for the most vulnerable. Issues and solutions in this paper focus on the following three areas: 1. Access to appropriate care, 2. continuity of care, and 3. social determinants of health.