actuaries in healthcare presented by: tim reilly, cfo l.a. care health plan april 25, 2014
Post on 21-Mar-2016
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•Expanding opportunities due to the Affordable Care Act (ACA)
•Examples in L.A. Care
•Health Plan tasks
•Questions
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•Affordable Care Act (ACA), otherwise known as Obamacare, is the driving force.
•Health Plans are expanding to meet expected enrollment growth.
•Actuaries and healthcare analytics play an important role.
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•2011 Revenue: $1.2 Billion•Current Revenue: $3.3 Billion•Projected 2017 Revenue: $7.5 Billion•Current Member Enrollment: 1.3 million lives•200,000 Medi-Cal enrollees added in January
2014.•40,000 Exchange/Marketplace enrollees since
January 2014.•20,000 Dual eligibles (Medi-Cal and Medicare)
during this year.
•Set insurance premiums
•Establish provider rates
•Develop risk stabilization and mitigation programs
• Reinsurance
• Risk adjusters
• Risk corridors
•Estimates reserves (IBNP)5
Questions?
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