Description: This project shows how to use agent-based models to simulate the behaviors of agents in complex health systems.

Description: To advise the management of a company on the most prominent disruptors that are going to increase its health expenditure in the next 5 years.

Description: This research report provides an evaluation and synthesis of the methodologies and data samples used on characterizing health care fraud.

Description: This SOA report describes the components of margin for calculating capitation rates in a Medicaid context along with practical issues that MCOs may face.

Description: The Society of Actuaries has developed and released a health care forecast model to illustrate the potential impact of the COVID-19 outbreak on insurance plan health care costs in the United States. Users of the model may include insurance company actuaries seeking an additional reference point for 2021 cost development, regulatory actuaries seeking additional insights and validation of costs as part of rating submissions for 2021, and insurance purchasers seeking a deeper understanding of the forces driving 2021 health care costs and premiums. The model is not intended as a replacement for existing modeling tools developed by insurers or regulators. Rather, the model’s primary purpose is to illustrate the key outbreak-related forces that are affecting the trajectory of health care costs. In addition the model can provide a common reference point to facilitate dialogue with respect to the regulatory review of 2021 health insurance rate filings.

Description: A report analyzing the cost of care for deceased cancer patients over the last six months of life.

Description: This project shows how to use agent-based models to simulate the behaviors of agents in complex health systems.

Description: This project shows how to use agent-based models to simulate the behaviors of agents in complex health systems.

Description: This 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: Recognizing the importance of fortifying risk adjustment programs against selection based on nontraditional variables, the Society of Actuaries’ Health Section sponsored an in-depth study into the relationship of nontraditional variables with health costs. This report presents the results of this study.