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