Description: Identifying and submitting all appropriate ICD-9 diagnosis codes to CMS will result in a higher risk score for the member and increased payments to Medicare Advantage plans. Milliman's HCC prevalence study illustrates the significant variations in HCC prevalence rates by age/gender, geography, and population type and will assist plans in benchmarking the effectiveness of their own diagnosis code capture efforts.

Description: This article introduces SymPy, a computer algebra system (CAS) for the Python programming language.

Description: Although rate structures where low-cost cohorts subsidize high cost cohorts may be justified from a actuarial, marketing, or legal standpoint, the subsidization creates risks which must be understood and monitored. This article presents the concept of subsidization signature to measure and interpret the effects of rate subsidization, and to assess the sustainability of rating structures and the sensitivity of business mix assumptions.

Description: A new health insurance pricing model takes external market prices into account, as well as regulatory rate restrictions and other traditional pricing factors. Rather than being assumed at the outset, lapse rates emerge from the model, along with assessment spiral & loss ratio projections. Under the model optimal pricing strategy depends on whether the class being rated has a healthier than average mix of risks.

Description: The guest editorial details some valuable lessons during the author’s career as an employee benefits (mostly retirement) consultant, turned P&C predictive modeling, reporting and data warehousing lead, turned an analytic strategist and independent consultant.

Description: In order to better develop skill in predictive analytics, the author suggests looking to professionals who design innovative predictive models and, more importantly, find effective ways to communicate their findings to a large audience.

Description: The article provides several examples of projects led by actuaries who are applying advanced data analytics and big data to solve industry-specific business problems.

Description: Using Healthcare Claims Data to Create Actuarial Models.

Description: The author recounts his experience as a keynote speaker at the Actuarial Research Conference and provides advice to young actuaries to present complex subjects in an understandable manner.

Description: A discussion of permissible use and collection of genetic information for Health Risk Assessments and wellness programs under the Genetic Information Nondiscrimination Act of 2008.