Description: This Society of Actuaries Research Brief has been constructed to highlight some of the key features of the pandemic and contemplate the risks for the actuarial profession to consider in their work.

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: In this third phase, Sibson interviewed three researchers and actuarial modelers. The objectives of the interviews were to gain perspective on the conceptual model, model alternatives, methodology, and data sources.

Description: An analysis of prescription drug use in the Kansas individual market

Description: This report presents the results of a study comparing health risk scoring models.

Description: View the following report regarding Risk Scoring in Health Insurance: A Primer.

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: 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: This document provides an explanation of the Health Company Pandemic Modeling tool excel workbook and gives step by step instructions for companies to enter specific scenarios and assumptions.