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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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