Universal Library of Business and Economics
An Integrated Financial Analytics Framework for Health Plans - Risk Pool Estimation, Reserve Modeling, and Strategic Forecasting in Medicare Advantage and Exchange Lines of Business
U.S. health plans operating in Medicare Advantage and the Affordable Care Act Exchange manage financial risk through three functions that are usually kept apart: IPA-level risk-pool estimation, IBNR reserve modeling, and state-level forecasting. This fragmentation causes the same underlying quantities to be estimated inconsistently, producing reserve inadequacy, forecast variance, and weak decision support. This monograph develops an integrated financial analytics framework that connects the three functions within …