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Actuaries in Healthcare Presented by: Tim Reilly, CFO L.A. Care Health Plan April 25, 2014

Actuaries in Healthcare Presented by: Tim Reilly, CFO L.A. Care Health Plan April 25, 2014. Today’s Talk. Expanding opportunities due to the Affordable Care Act (ACA) Examples in L.A. Care Health Plan tasks Questions. ACA Creates New Opportunities in Healthcare.

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Actuaries in Healthcare Presented by: Tim Reilly, CFO L.A. Care Health Plan April 25, 2014

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  1. Actuaries in Healthcare Presented by: Tim Reilly, CFO L.A. Care Health Plan April 25, 2014

  2. Today’s Talk • Expanding opportunities due to the Affordable Care Act (ACA) • Examples in L.A. Care • Health Plan tasks • Questions

  3. ACA Creates New Opportunities in Healthcare • 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. L.A. Care Health Plan as an example • 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.

  5. Health Plan Tasks • Set insurance premiums • Establish provider rates • Develop risk stabilization and mitigation programs • Reinsurance • Risk adjusters • Risk corridors • Estimates reserves (IBNP)

  6. Questions?

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