Description: Since health care reform has made accountable care organizations a hot topic, an SOA workgroup is addressing relevant questions, including provider risk under various ACO models, limitations of the Medicare model for motivating change in the health care delivery system, strategic priorities, attribution of members, meaurement, and the roles actuaries can play.

Description: A new initiative, Commercial Health Care: What’s Next, will focus on education and research for health actuaries regarding issues that remain with the ACA.

Description: The Health Section's strategic initiative entitled Commercial Health Care: What’s Next? focuses on health care reform. This article contains a summary

Description: This article will consider several issues arising from ACO budgeting and pricing of stoploss coverage, including: 1) attribution of members; 2) claim carve outs; 3) ambiguous stoploss terms; 4) providers gaming the system and 5) credibility of data.

Description: This article compares July 1 renewal premium trends to January 1 renewal premium trends by benefit plan.

Description: Argues that reinstatement of CSR (cost-sharing reduction) reimbursements by federal government will have destabilizing effect on individual market.

Description: Explanation of Medicare Advantage STAR rating program as it relates to payment rates for MA bids. Also describes important features of the program from an actuarial perspective, how the components of the STAR rating are calculated and implications and considerations for actuaries.

Description: Discussion of recent laws and regulatory changes that have provided Medicare Advantage plans greater flexibility in benefit offerings and plan designs.

Description: Excerpts from a conversation with Alan Mills regarding his work in complexity science and agent-based modeling.

Description: Recent health care reform activity has highlighted the importance of Clinical Integration in improving the quality, safety, efficiency and reimbursement infrastructure of the health care system. This article discusses relevance and implication of regulatory measures, implementation and data issues, and provides an end-to-end example.