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August 2026
Reframing Medical Cost Trend: A Decomposition Framework for Actuarial Practice
This article introduces a framework for decomposing observed healthcare cost trend into four distinct components: Continuous Drivers, Adoption Drivers, Level Adjustments, and Temporary Deviations. Using illustrative examples, the article demonstrates how each component affects healthcare costs differently over time and how their combined effects influence observed experience. The framework provides actuaries with a structured approach for interpreting trend data, distinguishing between persistent and non-persistent sources of cost change, and developing more informed pricing assumptions. By improving transparency around the drivers of healthcare cost growth, the framework can enhance both actuarial analysis and communication with stakeholders.
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August 2026
Beyond Expected Cost: Considering Volatility Metrics in Stop-Loss Underwriting
Stop-loss underwriting has traditionally centered on expected cost estimation through demographics, experience rating, credibility weighting, and trend adjustment. However, stop-loss indemnification is triggered by deviations from the mean, making variance and tail risk critical to financial performance. This article examines a retrospective actuarial analysis of a US stop-loss portfolio comprising 19 employer groups and 16,823 covered members, evaluating whether pre-bind dispersion signals predicted ex post performance. The findings revealed striking variance concentration: four groups in the highest-dispersion tier accounted for 52% of underwriting losses, producing a combined loss ratio of 171.9% compared to 55% for the remaining groups. A counterfactual model suggested that identifying these high-variance groups in advance could have reduced the portfolio loss ratio from 83.6% to approximately 55% and improved underwriting margin by 107%. With commentary from Joshua W. Axene, FSA, FCA, MAAA, the article explores capital implications of unidentified dispersion, considerations for operationalizing volatility metrics, and governance requirements including explainability, auditability, and back-testing. As specialty pharmaceuticals, gene therapies, and complex oncology protocols expand the right tail of cost distributions, explicit dispersion measurement may become an essential component of disciplined stop-loss underwriting.
Article
August 2026
Measuring What Matters: An Episode-of-Care Approach to the Maternal Health Crisis
Maternal health poses a growing financial risk to health plans, driven mainly by costly NICU admissions. The proposed fix: build a "perinatal episode of care" linking mom's and baby's claims across five stages—prenatal care, delivery, mom's postpartum period (3–12 months), baby's newborn period (up to 12 months), and refined inclusion/exclusion rules (e.g., excluding unrelated conditions, dual-coverage members, or pregnancies that didn't reach delivery). Existing models, like TennCare's and Ohio Medicaid's episode frameworks, offer a great starting point. The payoff: shifting from a per-member-per-month view to an "average episode cost" view enables better forecasting, more meaningful evaluation of care management programs (comparing baseline vs. measurement periods), and clearer ROI calculations for maternal health interventions—ultimately supporting both cost control and value-based payment models.
Article
June 2026
Rate Increases for Long-Term Care Insurance: An Interview with Fred Andersen
This Q&A-style interview explains why LTCI premium increases have become so significant; how regulators developed the MSA Framework to bring more consistency and fairness to state reviews; and how actuarial judgment, consumer protection, and insurer solvency are balanced in practice.
Article
June 2026
Actuarial Value Stack ROI Modeling
Comprehensive value modeling shows asthma therapy generates system-wide ROI through fewer exacerbations, productivity gains and lower societal burden.
Article
April 2026
Actuarial Budget Impact Modeling
Summary of the evaluation for the near-term payer cost implications of adding beclomethasone dipropionate/formoterol fumarate/glycopyrronium (BDP/FF/GP)—a new single-inhaler triple therapy (ICS/LABA/LAMA)—to U.S. asthma formularies upon anticipated 2026 FDA approval.
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