Friday, January 17, 2014

Blip Theory -- The Downfall of 401(k) Outcome Theory

Most of the non-regulatory material that I read about 401(k) plans these days deals with participant outcomes. In fact, outcome seems to be one of the big buzzwords for 2014. We are suddenly talking about financial outcomes, health outcomes, and every other kind of outcome you can think of.

Don't get me wrong, I think it would be great if we all have wonderful outcomes. I just don't believe the studies that tell us how to get there.

In the typical piece that I read, I learn that in order to get the best outcomes, participants should begin saving at the beginning of their working career, increase the percentage of their pay that they save over time and convert their account balance (one way or another) to an inflation-adjusted annuity for longevity protection.

That's great. And, when a smart person models what will happen if a young adult follows this guidance, that person will always be destined to have a highly prosperous retirement.

But, it seems that very few people, even those who started saving when they were fairly young, are actually on target to have that very prosperous retirement.

Why not? What happened?

Life happened.

None of these models seem to reflect real life. In real life, people have periods of unemployment. During that unemployment, they stop saving. In fact, to the extent that those people have not also saved well outside of their 401(k), many will need to take distributions from those very 401(k) plans (paying income tax and the early distribution excise tax) just to stay afloat.

Where is this event in the models?

In real life, many young people actually do start to save at a modest rate and gradually increase the amount that they save. But, in real life, many of those people choose to have children and some will have them without having made a truly conscious decision to do so. Kids cost more money than anyone seems to think they will. That increase in savings rate often fails to be sustainable.

Where is this event in the models?

In real life, in 2014, an awful lot of people participate in high-deductible health plans. They are told that one of the great tax benefits of the modern world comes to people who put money away in a health savings account (HSA) to fund the high deductible part of their plans. This is a great idea as well, but real wages have not been increasing for probably the last 15 or more years. This model expects participants to save upwards of 10% of compensation in their 401(k) plans and an additional, say, $4000 per year in their HSAs. That's a lot of money. I think more people than not would tell you that this is just not feasible.

Where is this conundrum in the models?

Purchasing an in-plan annuity or taking an annuity distribution in your 401(k) is often an excellent idea. But, not all plans have them. Among those that do, many are not offered on a particularly favorable or attractive basis. The models that I have seen use a current, no-profit basis for converting your account balance to an annuity.

Where can I get one of these annuities on which an insurer makes no profit?

I'm all for wonderful outcomes. But, somebody needs to merge blip theory with outcome theory. Under blip theory, and I have never heard the term used before the morning of January 17, 2014, just as the road to hell is paved with good intentions, the road to wonderful outcomes is paved with potholes hereinafter known as blips. When models start including realistic numbers of blips, I'll start to believe the expected outcomes.

Friday, January 10, 2014

Anther Application of Modern Portfolio Theory

Modern portfolio theory deals largely with the allocation of assets between asset classes in a portfolio. The field, grown predominantly from Markowitz's concept of the efficient frontier has been a hot topic among both investment professionals and more casual investors alike during my time in the workforce (no, that doesn't take us back to prehistoric times, just close).

Essentially, the most significant outgrowth of this concept is that there exists a continuum of allocations that maximize expected return for a given level of risk, or conversely, that minimize risk for a given expected return. All of this, of course, is based on a large set of assumptions, in this case, capital market assumptions. Oversimplifying somewhat, what Markowitz, and after him others, discovered was that you can reduce risk in a portfolio while sometime even increasing longer-term expected return.

That's pretty cool. Part of what we learned is the value of populating a portfolio with uncorrelated and inversely correlated assets. Okay, John, what does that mean?

Consider a two-holding portfolio. Suppose each holding has an expected return of 8% per year and that their returns are well correlated. In other words, when one goes up, the other is expected to go up by a similar percentage. And, when one goes down, the other is expected to go down by a similar percentage. Essentially, your diversification is not. You're not getting any additional benefit from the second holding.

Suppose instead, your tow holdings are somewhat inversely correlated. In other words, they are neither expected to perform particularly well nor particularly poorly at the same time as each other. The expected return of each holding doesn't change. But, by decreasing the overall risk of the portfolio, you are able to increase the long-term expected return of the total portfolio by decreasing volatility.

Now that we've got that straight, let's change our portfolio. Instead of looking at financial assets, let's consider the insured lives of a health insurance company. While less is known about correlations of costs among diverse populations, it seems clear to me that a homogeneous population carries with it a higher risk to the insurer than one that is not.

As an example, consider a population consisting of 100 insured lives, all of them men between the ages of 65 and 75. Without doing any research to get the correct percentage, my past reading tells me that a meaningful percentage of them are going to get prostate cancer over the next 10 years. That's a largely unavoidable occurrence, or so I read, and the claims could all come at the same time.

How would an insurer manage that risk (other than reinsuring or hedging in some other way)? Suppose they cut their population of insured age 65-75 males from 100 to 10 and added in 90 other insureds. Some of them might be of the type that represent a very low risk, say 20-30 year-old males. Some might be women in their 40s, mostly past the age that they will be in the maternity ward.

What it seems that we will find is that the more diversification that our insurer has in its portfolio, the less volatility in claims it will have over time. This is good for them.

Under the Affordable Care Act (ACA), again somewhat oversimplified, health insurers must pay out at least 85% of their premium dollars in medical claims. Suppose they develop a set of premiums whereby they expect to pay out, on average, 90% of their claims. Further suppose that the 90% average has a standard deviation of either 5% or 15%. If I am doing my math correctly, then in the case where the standard deviation is 5%, our insurer will only have to pay rebates in about 16% of all years. In the 15% standard deviation case, however, they will pay rebates in 37% of all years.

In a nutshell, here is what this means. Our hero, if you choose, the insurance company will keep its full profit in either 84% (100%-16%) of all years or in 63% of all years. Before rebates, their long-term profits will be identical, but managing their portfolio for lower risk allows them to actually keep more of their profits.

Another application of modern portfolio theory?

Wednesday, January 8, 2014

The Useful and Not so Much of Wellness Programs

A friend and reader referred me to this New York Times article that discusses a DOL-commissioned study performed by the RAND Corporation and PepsiCo. The study looked at wellness programs to determine the relative values of disease management components and lifestyle management components.

I was surprised that the results were so glaring. I'll get into that difference in just a minute.

First, for readers who don't deal in this area every day, it's useful to explain what we are talking about here. Disease management programs target people with chronic illnesses by educating them about their risks, reminding them to see their physicians, and reminding them to take medications. Lifestyle management programs focus on things such as stress management and weight loss.

The study found that disease management produces very meaningful cost savings, but lifestyle management results in virtually no savings at all. First and foremost, the PepsiCo disease management program has reduced hospital admissions significantly, and hospital admissions are one of the leading contributors to high medical claims costs.

Personally, I think there is more to the difference than what appears in the NYT article. Consider a patient with hypertension (high blood pressure). That blood pressure can be measured. There are prescription drugs whose primary purpose is to get a patient's blood pressure under control. Taking that medication once a day is easy as long as you can remember to do it. For most people, since the medications usually don't have severe side effects, there is nothing discomforting about doing this. Patients see the improvements and they are happy. Statistically speaking, a person with normal blood pressure is less likely to be admitted to the hospital than a hypertensive person. And, blood pressure medication is not among the more expensive ones.

How about lifestyle management? How exactly would I measure stress? How exactly would I control my stress? How would I know that my stress was reduced?

To my mind, these are all largely indeterminable elements. I know when I feel less stressed, but it's usually not something that can be controlled. If I think I will have trouble paying my bills, I will be stressed. If I think I will lose my job, I will be stressed. If a family member is ill, I will be stressed. No stress management program can change this.

Looking at the numbers cited in the study, the disease management program saved nearly $4 for every dollar spent on it while the lifestyle management program saved only about 50 cents for every dollar spent. In total, the program saved nearly $1.50 for each dollar spent.

One could look at this in several ways. We could say that the program in total is working. We could say that PepsiCo should eliminate the lifestyle management component. What we can't say is that disease management doesn't work.