Advanced syllabus changes
This page describes the changes made to the Advanced syllabus for the Spring 2019 exam.
The following study notes were added:
- GHA-122-19 : Episode-Based Physician Profiling: A Guide to the Perplexing– This paper discusses how patient data algorithms can be used to attribute an episode of care to a physician. Then measures of quality can be traced back to that physician, and can then lead insurers to steer members to the best providers.
- GHA-123-19: Physician Cost Profiling-Reliability and Risk of Misclassification – This paper looks into how well the profiling models work. They are used to classify physicians into “good and bad” buckets, but how often do the models give the wrong answer?
- GHA-124-19: Medicare Shared Savings Program in the Quality Payment Program – This CMS power point is a high level summary of how clinicians can join Alternative Payment Models (APMs). The ACO shared savings model, which is discussed in multiple papers on this syllabus, is an example of an APM.
The following articles were added:
- Design and Pricing of Tiered Network Health Plans, Health Watch, May 2009 – This paper discusses how to estimate the savings that can be achieved when members are steered to lower cost clinicians via lower out-of-pocket cost sharing benefits.
- The Role of the Actuary in Self-Insurance, May 2018, sections 4, 5 and Appendices – The SOA dropped a stop-loss paper and in turn brought on this SOA sponsored paper. The paper discusses topics that many employer benefits actuaries review today including: regulations that employers need to follow, self-insured vs full insured, and stop-loss in its many forms. The appendix also includes a few excel spread sheets that show how to price stop-loss insurance using CPDs.
The following textbook sections were added:
- Duncan Chap 22.6-22.7: Healthcare Risk Adjustment and Predictive Modeling 2nd Edition 2018
- A second Duncan text added to this syllabus. This short section covers two main topics: calculating the benchmark costs for an ACO shared savings model and recent changes that have been implemented for the shared savings model.
No Actuarial Standards of Practice were added.
The following items were modified:
- GHA-114-19 Canadian Standards of Practice, sections 2130 and 2300 has been adjusted
- Skwire chapter 33: Health Risk Adjustment has been reduced to pp.571-577
The following items were moved to background only:
- Duncan chapter 4: Actuarial Issues in Care Management Evaluations
- Duncan chapter 10: Measuring Care Management Savings Outcomes
Finally, the following items were removed from the syllabus:
- Kongstvedt chapter 10: Data Analysis and Provider Profiling in Health Plans
- Kongstvedt chapter 11: Prescription Drug Benefits in Managed Care
- Kongstvedt chapter 12: Introduction to Managed Behavioral Health Care Organizations
- Duncan chapter 1: Introduction to Care Management Interventions (Previously listed as background material only)
- Duncan chapter 2: Clinical Background (Previously listed as background material only)
- Duncan chapter 6: The Use of the Value Chain in Care Management Program Planning
- Duncan chapter 14: Random Fluct. & Validity in Measuring DM Effectiveness for Small Populations
- GHA-112-16: The Road to Accountable Care: Building Systems for Population Health Management
- ASOP #28: Statements of Actuarial Opinion Regarding Health Insurance Liabilities and Assets
- GHA-104-15: Actuarial Aspects of Employer Stop Loss
- ASOP #45: The Use of Health Status Based Risk Adjustment Methodologies
As of early December 2018, the spring 2019 case study has not been posted. Check the SOA Updates web page for further details. The last changes were only non-formatting changes to the case study are: (1) calendar years were updated by 1, and (2) the email on page 20 was modified.