4 things to know: Continuing care at home

2. CCAH managers know about private long-term care insurance (LTCI).

In the acute medicine world, doctors, hospitals and insurers talk about each other, and complain about each other, all the time.

LTC providers and LTCI issuers seem to have a more distant relationship, in part because the people getting the care and their relatives usually file the claims with the insurers.

But Spellman said a typical CCAH manager may look at any private LTCI coverage an individual has and use the LTCI benefits to pay part or all of the CCAH costs.

3. CCAH managers often use LTCI actuaries to manage care resources.

Paulis and Borcik said CCAH managers face many of the same concerns that LTCI issuers face, such as dealing with the possibility that residents will be sicker than expected, or live longer than expected.

CCAH managers also rely on some of the same risk-management strategies that LTCI issuers use, such as strong marketing and careful medical underwriting, the actuaries said.

4. The Actuarial Standards Board has developed a reporting standard for CCAH.

A CCAH is supposed to report on its operations using Actuarial Standard of Practice Number 3, which was developed in 2007 and updated in 2011.

A CCAH must report on its actuarial funded status, its pricing margin, and expected cash flows.

Powell and Lampo said managers of a CCAH may have a hard time using early experience to project what overall experience will be like. They said good CCAH managers should set conservative assumptions, analyze experience data and validate projections every year, and collaborate with others to get data they can use to benchmark the performance of their own CCAH.