Description: Discover the key components of value-based care (VBC) contracts and their impact on provider credibility. Learn about benchmarks, measurement period results, and the unique challenges providers face in managing insurance risk. Gain insights into reducing costs and aligning financial incentives in the US healthcare market.

Description: Article describing content and key takeaways from experience completing the SOA PA Certificate

Description: Highlights of two 2018 health events organized by the Colombian Association of Actuaries and sponsored by the Colombian Government. Seminar on Risk Adjustment and Predictive Modeling in Health. Seminar on Risk Management for the Health Insurers

Description: Health claims are not normally distributed. Claims Forecasting can be improved by understanding the entire distribution of plausible values of future claims, for example knowing there is an 80% chance future claims are between $340 and $375 PMPM. Confidence intervals around our estimates allow us to understand for each range around the best estimate (for example +/- 1%) what is the probability that future claims will fall in that range. Quantile Regression is a mathematical technique where you can estimate any percentile of the claims distribution you are looking for as a function of demographics, diagnosis indicators, prior cost variables, or other significant predictors. You can see which coefficients are important at different parts of the distribution. Individual and group distributions can be constructed. There are numerous applications in pricing and underwriting, stop loss, provider profiling, ACO target setting, allocation of group risk charges based on volatility, discounting strategy, and experience analysis.

Description: In recent years, vast amount of data from emerging experiences has helped insurers gain a deeper understanding of their policyholders and the factors driving their behaviors. However, due to limitations in traditional experience study methods, this understanding typically remains at the cohort level. This series of articles proposes a novel machine learning-based model that analyzes and predicts policyholder behaviors at the individual policy level. Policyholder embedding representations are learned using a Recurrent Neural Network (RNN) that takes into account the sequence of historical transactions associated with a policy. Additionally, a Neural Network with a multi-head architecture is trained to predict the policyholder's next action based on the policyholder embedding and other policy attributes. The resulting model offers several advantages over traditional experience studies and assumption-setting methods, including the ability to set policy-level assumptions that improve reserve accuracy, predict multiple behaviors simultaneously while capturing the interrelationships between them, and generate policyholder embedding representations that are useful for segmentation.

Description: We compare two predictive analytics methods - GLM and GBM in terms of predictiveness vs. interpretability.

Description: Regression to the mean is a phenomenon that arises when comparing sequential data points. It states that when an initial observation is extreme or an outlier, future observations will be closer to the average. Health care actuaries need to understand and be able to mitigate the effects of regression to the mean to avoid misapplying predictive models or misstating measurements of historical effects.