Description: These past two years have been the most challenging of my professional career, and I’m certainly not unique in this regard. Fortunately, I’ve benefited from a little help from my friends in the actuarial community—no one sticks together like actuaries.

Description: Healthcare risk adjustment methodologies have become increasingly complex, largely due to the belief that complexity enhances accuracy. However, a disconnect exists between how healthcare risk is assessed and how payments are adjusted. This article explores the stark difference between measuring the accuracy of a risk assessment model at a member level, and that of a risk adjustment mechanism at the health plan level. I show that a highly simplified approach that does not use diagnosis codes can have similar accuracy on risk adjusted payments to models that do. These findings suggest that accuracy is not a barrier to developing simpler risk adjustment methodologies, which can improve payment accuracy and reduce the financial incentive for coding diagnoses.

Description: There is a big wave of changes coming to the pharmacy market. The extent is not yet fully known, but there are trends we can follow that help us predict. Biosimilar uptake is key to driving savings, but it can take a while to ramp up. Biosimilars bring competition, and this coming wave will bring unprecedented Biosimilar competition.

Description: This article is an update on the No Surprises Act, which is a U.S. Act aimed to reduce the risk that a person unexpectedly receives out of network charges for their health care visits. This is Part 2; Part 1 was featured in Health Watch's Sept 2024 issue.

Description: Article reviews the data a year into the unwinding of continuous coverage provisions in Medicaid, the impact on enrollment counts, how capitation rates have been adjusted, and compares those results to what has been modeled with the SOA Mediciad Unwinding model.

Description: This article is a concise guide to assist health actuaries with CPD attestation. It describes the requirements of United States Qualification Standards and the SOA Basic Requirement provisions of Section B. It also describes when each set of standards are appropriate.

Description: On July 19, 2021, the Health Section and the Reinsurance Section of the Society of Actuaries (SOA) cohosted a webinar titled “Modeling the Financial Effects of Emerging Cancer Treatments,” which provided an overview of rapidly evolving cancer therapies, including cell therapies (CAR Ts), gene therapies and specialty drugs.

Description: 2021 SOA Health Meeting Recap

Description: This Q&A article discusses the use of machine learning to analyze unstructured data. Supriya Ramachandra, a data scientist at SIKKA, explains how her team uses natural language processing techniques, technical aspects of neural networks, LSTM modeling, and natural language processing. Machine learning allows for the classification of large amounts of unorganized data, providing actionable information for actuaries.

Description: Introduction to additional actuarial research into development of and regulatory impact, economic impact and consumer impact of prescription drugs in the United States. Intended to further educate actuaries and others who work in this area and motivate more actuarial involvement to increase transparency, increase competition, better align stakeholder incentives and better mitigate total cost of care increases