Health

Predictive Modeling with Consumer Data

Submitted by matt on Tue, 11/01/2011

Here's how using consumer data will affect the way health insurers make decisions on what products to sell.

Can Predictive Analytics Revolutionize Risk Management for Health Insurers?

Submitted by matt on Mon, 09/05/2011

When we think of predictive analytics in insurance, perhaps it calls to mind weather risks, earthquake exposures or other types of disasters, but newly-reported research indicates that a form of predictive analytics will be of great use to health insurers, who should be able to geographically localize the spread of diseases, and in turn, better assess health risks.

Benefit Designs for High-Cost Medical Conditions

Submitted by Kathleen McGrath on Wed, 07/27/2011

This Milliman Insight paper provides an actuarial view of high cost patients and how their incurred medical costs are allocated between the health plan and the member. We present the cost burden high cost patients incur under less generous coverage as well as actuarially equivalent benefit design changes that can protect high cost patients. The authors chose to define high cost or catastrophic patients as those who incur over $100,000 in allowed medical claim costs in a year. This paper was commissioned by Genentech, Inc.

Behind the numbers: Medical cost trends for 2011

Submitted by Kathleen McGrath on Wed, 07/27/2011

This annual report from PwC on medical cost trends was published in June 2010 and factored the impact of many variables including the US economy, which continues to emerge from a deep recession, as well as healthcare reform, which has phased-in milestones that begin in 2011. Increases in medical costs are expected to be slightly less than last year but still are projected to significantly outpace the rate of inflation raising questions about sustainability and if health reform can truly create greater efficiencies and cut costs.

PPACA: NAIC Ices Agent Comp MLR Exclusion Effort

Submitted by Kathleen McGrath on Wed, 07/13/2011

The National Association of Insurance Commissioners (NAIC) has backed away from the idea of supporting a congressional bill that could exclude insurance agent compensation from medical loss ratio (MLR) calculations.

Presentations from the SOA 2011 Health Meeting, held on June 13-15, in Boston, MA

Submitted by Kathleen McGrath on Wed, 06/29/2011

Topics include:

  • What Does the Future Hold for Underwriting?
  • USA Health Reform: What USA Actuaries Can Learn from Experiences in Other Countries
  • Enterprise Risk Management for a Health Insurer: Like Life, Like Casualty, or Something Completely Different? A Cross-Pollination of Thought
  • Avoiding Statistical Pitfalls in Actuarial Work
  • Actuarially Sound Rates vs State Budget Reality: What's an Actuary to do?
  • The Economics of Obesity
  • Mortality Issues for Group Life Insurance
  • Disability Experience Studies

...and more.

Fair Risk Assessment in Life & Health Insurance

Submitted by Kathleen McGrath on Wed, 06/15/2011

This Swiss Re report examines the private insurance pricing and risk selection process, risk selection and the regulatory environment, and evidence-based ratings and their application.

Congress Considers Interstate Health Insurance Sales

Submitted by Kathleen McGrath on Wed, 06/01/2011

Witnesses tell House committee that cross-state sales would reduce the number of uninsured.

Top 10 actuarial issues for a health exchange (Milliman)

Submitted by Kathleen McGrath on Wed, 05/18/2011

In order to create a financially self-supporting healthcare exchange, a state needs to make a number of critical decisions, such as whether to make the exchange mandatory or voluntary and whether to merge the individual and small group markets. Each state will need to address its own priorities based on its own specific situation and healthcare environment. This article discusses the top 10 actuarial concerns surrounding the formation of a healthcare exchange.

2011 Milliman Medical Index

Submitted by Kathleen McGrath on Wed, 05/18/2011

The annual Milliman Medical Index (MMI) measures the total cost of healthcare for a typical family of four covered by a preferred provider plan (PPO). The 2011 MMI cost is $19,393, an increase of $1,319, or 7.3% over 2010. Even though the rate of increase is slowing from prior years, it has taken fewer than nine years for such costs to more than double. In 2002, the cost of healthcare for the typical family of four was $9,235.

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