Important work happening at Milliman

LARA/wellness

Milliman has developed new Long-term care Advanced Risk Analytics (LARA)® LTC risk scores based on IntelliScript’s Irix identified medical and pharmacy data to guide underwriting and case management. To learn more about conducting a study, please reach out to: Mike Hoyer, Principal and Director, Irix Product Strategy; Robert Eaton, Principal and Consulting Actuary; or [email protected].

Milliman continues to assist companies using LARA to establish test and control groups, evaluate the feasibility of wellness programs, and measure the effectiveness of programs that have been in flight. LARA risk scores continue to be used to stratify populations for pre-claim wellness programs and targeted outreach. The team is also building capabilities to use LARA risk scores in additional areas, such as fraud, waste, and abuse identification.

Experience studies

How to account for post-pandemic experience has been on the mind of LTC actuaries since the pandemic was ongoing. A recent American Academy of Actuaries issue brief provides guidance as it explores areas of uncertainty facing actuaries performing LTC experience studies. Through our work in this area, we have found there is no one-size-fits-all answer. Instead, we have found that the decision of if and how to incorporate post-pandemic experience often varies from company to company and even assumption by assumption within a company. To assist with this, we have utilized predictive modeling techniques for clients to identify an experience period for each assumption study that utilizes post-pandemic experience, where appropriate.

Milliman Integrate LTC First Principles model capabilities

Milliman’s Integrate LTC First Principles model offers a powerful, cloud-based solution for LTC actuarial analysis and modeling. Integrate is Milliman’s advanced and secure modeling platform designed to streamline and enhance actuarial workflows, leveraging the scalability of the cloud. Our internal version of the LTC First Principles model is loaded with our 2023 Guidelines to provide a strong starting point for analysis. We can easily load a specific company's in-force data to validate and compare results with their projection model. While an initial run may not capture every nuanced policy feature unique to a company, the model is highly flexible and can be refined through collaboration to ensure alignment with specific product details and business needs. This approach allows for efficient validation and benchmarking, supporting more robust decision-making and model governance.

Milliman holistic SAA/ALM optimization

Milliman’s advanced Strategic Asset Allocation (SAA) and Asset-Liability Management (ALM) solutions empower long-term care insurers and asset managers to optimize balance sheet management, capital efficiency, and value creation. Our unified analytical framework delivers holistic insight into the interplay of assets, liabilities, and capital under evolving regulatory environments, enabling informed decision-making, dynamic risk management, and efficient scenario analysis. Leveraging deep actuarial expertise and cutting-edge technology, we help clients integrate liability-aware investment strategies, enhance product pricing, and achieve sustained business growth—all while navigating complex regulatory requirements and expanding investment universes. Our robust, scalable analytics provide support for companies in addressing today’s challenging market landscape for managing long-tailed liabilities like LTC and realizing their long-term objectives. If this is of interest to your organization, please contact Fiona Ng.

Upcoming studies

LTC Guidelines

We are gearing up for the next iteration of the LTC Guidelines and have already collected a significant amount of data. The Guidelines are comprehensive benchmarks that can be used for various purposes. If you would like to contribute to the Guidelines research, have questions about the data request, or would like to provide feedback to enhance the Guidelines, please reach out to us at [email protected]. We are excited to see how post-COVID data is beginning to emerge across the market.

Combination products

Milliman LTC consultants are conducting the fourth Combination Product Experience Study. This study is the largest of its kind, collecting and summarizing experience for combination or “hybrid” products that couple life or annuity benefits with LTC or chronic illness riders. We will evaluate policyholder incidence rates, claim termination rates, lapse rates, and overall insured population mortality.

Participating companies will receive a free copy of the report summarizing our results. The study also enables Milliman to assist clients with assumption-setting based on industrywide benchmarks.

If you would like to know more or if you would like to participate in the study, please contact Anders Hendrickson or [email protected].

Industry news

Aging-in-place summit

This fall, several Milliman LTC and Milliman LARA consultants traveled to Louisville, Kentucky to attend the Prudential Peak® AgeTech Challenge™ Pitch Competition held at Thrive Center Inc. Thrive is a hub for innovative technology that supports healthy aging and longevity at home for older adults.

During our visit, we also participated in a wellness summit co-sponsored by Faegre Drinker, Milliman, and The Helper Bees. At the summit, we heard from various carriers about how they are navigating opportunities and challenges now that they are a few years into implementing wellness programs. The discussions provided valuable insights into the evolving landscape of wellness initiatives in the aging and long-term care space.

Caregiving documentary

The recent PBS documentary on caregiving in the U.S. offers a compelling look at the realities faced by caregivers nationwide. The film highlights caregiving as a universal experience, often not considered until people unexpectedly assume the responsibility. The documentary’s stories reveal the hidden nature of caregiving that is too often overlooked by both society and public policy. Stories of young children managing caregiving responsibilities while navigating their own childhood are especially impactful, illustrating the complexity of the issue.

The documentary emphasizes the ongoing need for policies that better support caregivers, who routinely face systemic challenges and insufficient resources despite carrying a substantial societal burden. It notes that unpaid caregivers far outnumber paid professionals in the U.S., and that the lack of adequate benefits and support has persisted for decades. The film also draws attention to the interconnectedness of caregiving with broader economic and legislative trends, highlighting the difficulties in passing meaningful reforms. As we continue to engage in industry research, we recognize that solutions to address these long-standing problems are necessary to ensure the availability of adequate care across the country.

OneAmerica Leading Tomorrow: Long-Term Care Summit

Jeff Levin of OneAmerica provided the following summary of OneAmerica’s Long-Term Care Summit:

“The Leading Tomorrow: Long-Term Care Summit, hosted by OneAmerica Financial on October 7, highlighted the emotional, medical, and social dimensions of caregiving while emphasizing the importance of compassionate, human-centered care. The event opened with the Stenz family’s heartfelt story of navigating Alzheimer’s, sharing both challenges and hope through openness, resilience, and love. A panel discussion about the PBS documentary Caregiving, featuring journalist Richard Lui and others, underscored the universal realities of caregiving and called for a “care-aware economy” that better supports families and workers. Medical experts like Dr. Donna Wilcock and Dr. Marc Milstein shared new optimism in the fight against dementia—from recently approved Alzheimer’s drugs that slow cognitive decline to lifestyle habits that help prevent it. The summit concluded with actionable insights from OneAmerica’s Amy Chinn and Amada Senior Care’s Tafa Jefferson, stressing the need for planning, empathy, and collaboration in caregiving. Overall, the day reinforced that while caregiving is complex and demanding, it is also deeply human—grounded in love, purpose, and hope for a better tomorrow.”

CLTC Leadership Summit

CLTC hosted its 4th annual Leadership Summit on September 16 and 17 in Milwaukee, Wisconsin. A small, select group of leaders from carriers, distribution, and industry partners was invited to listen, discuss, and debate important topics impacting the LTC insurance industry. Topics included:

• Why supporting working caregivers—the fastest-growing segment of the workforce today—is a business imperative
• How to move the needle and get more registered investment advisors (RIAs) and broker-dealers (BDs) talking about LTC planning
• A CEO roundtable to discuss the challenges, opportunities, and obstacles facing our industry
• How the home care industry is changing, how we meet those challenges, and opportunities that lie ahead

In addition, a half day was exclusively devoted to “How we are delivering on the promise”—all things claims and how the industry battles negative press attention. It was a highly successful event that facilitated discussion and consideration of important topics impacting our industry, as well as providing opportunities for professional networking.

M&A work

Dreamscape Industries completed its acquisition of LifeSecure Insurance Company on October 3, 2025. The LifeSecure legal entity includes approximately $700 million in LTC reserves. Dreamscape is a privately held investment firm.

On November 6, 2025, Aquarian Capital announced that it will acquire Brighthouse Financial in a $4.1 billion deal. The Brighthouse legal entity includes reinsured standalone LTC business and hybrid LTC policies. Aquarian Capital, a global investment holding firm, focuses on insurance and asset management investments and is backed by U.S. and Abu Dhabi private equity firms. Milliman was an advisor on this deal.

LTCIF annual conference

Milliman consultants attended the annual LTC International Forum (LTCIF) conference in Scottsdale, Arizona from October 21 to October 23. Sessions covered topics across a wide range of operational areas, from initial underwriting to claim management. Presenters discussed how they are using new AI tools and various data sources, including Milliman IntelliScript solutions, to optimize their workflows and improve performance within their organizations. Highlights included a keynote by Deborah Kan of Being Patient, discussions around a new medical test to identify markers of Alzheimer's disease (AD), and a recent court case where a carrier won a significant judgment against an LTC claimant accused of fraud.

NAIC LTC Actuarial Working Group

As mentioned in our last issue, the National Association of Insurance Commissioners (NAIC) LTC Actuarial Working Group voted at its June meeting to adjust the cost sharing used in the Long-Term Care Insurance Multistate Rate Review Framework (LTCI MSA Framework). The Health Actuarial Task Force voted in favor of the changes at its July 14 meeting and the Health Insurance and Managed Care Committee voted in favor of the changes at its August 13 meeting. The changes now await final approval by the Executive Committee in December.

Milliman publications and news

Broker World Survey

The 2025 Milliman Long-Term Care Insurance (LTCI) Survey is the 27th consecutive annual review of stand-alone LTCI published by Broker World magazine. This report analyzes both the worksite and total stand-alone LTCI market, including sales distributions, claims, and underwriting trends, and provides a review of available stand-alone products.

Notable enhancements to this year’s article include a new report structure to improve readability with links to navigate through various sections of the report.

Alzheimer’s healthcare costs

AD continues to pose significant challenges, with 6.9 million Americans currently living with the condition—a figure projected to double by 2060. The introduction of disease-modifying therapies (DMTs), such as anti-amyloid antibodies, marks a pivotal shift in the approach to AD care. These therapies, which target the underlying pathology of the disease, offer hope for slowing progression and improving quality of life for patients and families.

The AD patient journey is evolving: diagnosis now often includes biomarker confirmation through PET scans or lumbar punctures, and ongoing treatment requires regular MRI monitoring to identify potential side effects like amyloid-related imaging abnormalities (ARIA). High-risk populations, including APOE4 carriers, require additional vigilance. Despite these advances, access to DMTs remains limited due to cost, logistical challenges, and the need for specialized testing.

The drug development pipeline for AD is robust, with over 100 therapeutic agents in various stages of clinical trials. Future innovations may include oral DMTs, blood-based biomarkers for easier screening, and digital cognitive assessment tools, which promise to enhance early detection and expand treatment accessibility. These advancements could significantly reshape care delivery models, impacting long-term care planning, resource allocation, and cost management.

For LTC insurers and providers, staying informed about developments in AD therapies is crucial. The potential for earlier diagnosis and intervention, coupled with changing treatment protocols, may influence morbidity assumptions, policyholder needs, and claims experience. As the treatment landscape continues to shift, ongoing collaboration between clinicians, researchers, and LTC stakeholders will be essential to support optimal patient outcomes and sustainable care solutions.

Please reach out to [email protected] for more information.

Investments, ALM, and SAA

Milliman remains at the forefront on topics involving ALM, SAA, and complex asset modeling. In addition to conducting AG-53 analyses for insurance company portfolios, we continue to provide advisory services on the implementation of the Principal-Based Bond Definition (PBBD), effective January 1, 2025. Our commitment to industry leadership is further demonstrated through the completion of several in-depth research reports, including:

• Our annual report on “Asset Allocations and Investment Strategies of U.S. Life Insurers in an Inflationary Interest Rate Environment.” This report summarizes investment trends as observed from the 2024 statutory filings of all U.S. life insurers. For further information, please contact Fiona Ng.
• Our annual report on default cost studies for “Corporate Bonds, Private Bonds, Municipal Bonds, and Structured Securities in the U.S.” For further information, please contact Lucy Ouyang.
• A research report on “Complex Assets in Insurance and Annuity Industries” will be published in December by the SOA. This research provides detailed information on the analysis and modeling of complex assets in actuarial valuations. For more information, please contact Lucy Ouyang, Fiona Ng, or Jim Stoltzfus.
• In 2026, Milliman will publish two additional research papers on “Complex Asset Modeling” and “Asset Modeling.”

Milliman in the community

Africa Scholarship Programme

Two applicants, Dennis Muchemi Mabishi and Ndegwa Paul Victor, both from Kenya, were awarded full scholarships under the Africa Scholarship Programme, a joint initiative by Milliman and the African Risk Capacity Limited (ARC Ltd.). Launched in 2023, the Africa Scholarship Programme supports students from all African countries pursuing postgraduate studies in fields related to actuarial science, insurance, and risk management. Beyond funding education, Milliman and ARC Ltd. provide internships and mentorship opportunities to ensure that scholars gain the knowledge and the practical experience required to shape the future of climate-risk management in Africa.

Please reach out to a Milliman consultant to discuss any of these topics or other related items that interest you.