Description: This article is focused on sustainability concerns in the ACA individual markets and what we can learn from core actuarial principles as discussed in ASOPs.

Description: Table from an article in The Actuary Magazine on an analysis of risk management terminology: your guide to speaking ERM with different industries. Volume 4, Issue 6

Description: Appendixes for the Evaluating ACO Efficiency: Risk Adjustment within Episodes study. The study aims to answer the question of how much of an episode’s cost and use of specific services can be attributed to the patient’s own health status, as opposed to being driven by other factors such as the care setting, patient preference, and provider practice patterns. In other words, do episode costs vary so widely because of patient characteristics, including health status, or are they related to other, nonclinical factors?

Description: The purpose of this study is to evaluate the predictive accuracy of the commercially available claims-based risk assessment tools under different sets of conditions and with different sets of available information.

Description: Statement of the American Council of Life Insurers on Pandemic Influenza Preparedness in the Financial Services Sector before the Subcommittee on Oversight and Investigations of the House Financial Services Committee of the United States Congress, June 29, 2006

Description: A physician discusses white matter lesions on the brain - their nature, causes, severity, importance, associated risks, and underwriting implications for long term care insurance.

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: Through the sponsorship of the Robert Wood Johnson Foundation, The Society of Actuaries partnered with Wakely to use their health care data to study the effects of COVID-19 on overall health care claims for individuals with a COVID-19 diagnosis. The conclusion of the study is that individuals with COVID-19 claims had significant increases in health care costs leading up to their months of diagnosis, as well as in the months following their diagnosis. These effects were more pronounced for individuals who were hospitalized due to COVID-19 as well as for individuals with prior co-morbidities. Finally, the overall health care costs of these members plateaued at significantly higher levels than their pre-COVID baselines. In fact, all the main membership cohorts experienced claim levels that were at least 20% higher than their pre-COVID starting points.

Description: In this session, Deana Bell, FSA MAAA provides a comprehensive introduction to the Medicare Risk adjustment Program. Deana is a Principal & Consulting Actuary in the Seattel office at Milliman. She has been working with Medicare Advantage throughout her career as an actuary. Her expertise includes actuarial opinions, pricing, rating, reserving, medical underwriting, benchmarking, and risk adjustment projects. IN this session she sheds light on how Medicare Advantage health plans are compensated by the Centers of Medicare and Medicaid Services (CMS) through risk adjusted revenue. She highlights the significance of risk adjustment in ensuring financial stability for Medicare Advantage plans. Contributors: Deana Bell, FSA MAAA ; David Koenig, FSA, MAAA, John Dawson, FSA, MAAA, Jon Forster, ASA, MAAA