2

•Expanding opportunities due to the

Affordable Care Act (ACA)

•Examples in L.A. Care

•Health Plan tasks

•Questions

3

•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.

4

•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?

6