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Comparison of Risk Adjustment Programs—California Medicaid Managed Care Versus CMS Medicare Advantage, PART II
Risk Adjustment (RA) is a key component for CMS Medicare Advantage program and California Medicaid Managed Care program. While both RA programs follow generally accepted basic principles, their underlying methodologies and assumptions are quite different. Due to recent events, such as COVID-19 Public Health Emergency and Medicaid redetermination delay and restart, it adds complexity to Risk Adjustment. This is a hot topic in the industry and has significant impact to health plans. Keeping current with Risk Adjustment program changes and understanding the commonalities and differences of these two government Risk Adjustment programs is important to our health actuaries. This article compares and contracts these two risk adjustment programs’ methodology and assumptions as well as special considerations due to serving different populations. This is Part II of the two articles on this topic. -
Meet Hybrid Data: A Blend of Alternative and Traditional Data. A Case Study to Construct an Improved Inflation Index
In the following article, I introduce the concept of “hybrid data,” a combination of alternative and traditional data, which I illustrate through an example on inflation, to be of better value than considering purely a traditional data or alternative data source alone. We present a case where we use alternative data from Zillow, to improve upon the Consumer Price Index (CPI), and thus create an index that is more pertinent to consumers and investors alike. -
Reproducible Research
This article summarizes use of programming collaboration tools and source and version control (SVC) to make research products reproducible. -
Reflecting on the 2021 “Introduction to Modeling Bootcamp” and Changes for 2022
In July 2021, the SOA Modeling Section ran an “Introduction to Modeling Bootcamp” aimed at beginner modelers and students. This article discusses last year’s bootcamp, anticipated changes for this year’s bootcamp, and how you can get involved! -
Integrated and First Principles Modeling for Hybrid Life and Health Products
This article discusses the two main model types for modeling Hybrid Life and Health products - a claim cost model and an integrated first-principles model - and the pros and cons of each. This article also discusses how these models are constructed in practice, including common approaches and assumptions, and ways to model interplay of assumptions and sensitivities.
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