Description: The Affordable Act's risk corridor program is a temporary feature that applies to individual and small group QHPs from 2014 through 2016. Designed to protect insurers against pricing uncertainty, the program appears straightforward but has many subtle consequences. In this article, we review the need for risk corridors, the calculation itself, and the implications that result.

Description: This article compares the Prescription Drug Plan (PDP) market to the commercial individual market exchanges included in the Affordable Care Act. PDP carrier actions to date could help predict certain aspects of the exchange market.

Description: This article discusses new opportunities for states to waive certain marketplace requirements of the Patient Protection and Affordable Care Act. The article focuses on specific opportunities for states and the role that actuaries will play.

Description: Discussion of the impact of the ACA on RBS and required surplus for a health plan

Description: New research shows that we often make sub-optimal choices, when selecting a health insurance plan, that lead to unnecessary out-of-pocket expenditu

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: Article is a detailed discussion of the Risk Management and Own Risk and Solvency Assessment (RMORSA) Model Act that was recently approved by the NAIC and is being adopted by legislatures across the country.

Description: This article contains excerpts from the first three articles that were released through the strategic initiative - Commercial Health Care: What’s Next?

Description: As providers are considering accountable and value based care models, it is critical to strategically think through how to achieve a sustainable business model into the future. This requires actuarial and clinical/provider capabilities to assess the care management and financial levers to help a client through the transition.

Description: Mental health spending has reached $147 billion in the United States with demand only increasing greatly impacting society as nearly 1 in 5 experience these issues. There are even more indirect costs associated with mental health causing a national crisis surpassing 1 percent of the GDP. These costs coupled with the severe lack of licensed clinicians calls for an innovative solution. Through years of development and completion of a randomized controlled trial, Prevail has built and validated a low-cost, scalable solution. Prevail's clinically proven digital mental health treatment provides increased access to care while reducing overall health costs. Private and public payors should being reimbursing this model and offering it to their members.