Description: A new health insurance pricing model takes external market prices into account, as well as regulatory rate restrictions and other traditional pricing factors. Rather than being assumed at the outset, lapse rates emerge from the model, along with assessment spiral & loss ratio projections. Under the model optimal pricing strategy depends on whether the class being rated has a healthier than average mix of risks.

Description: This article discusses some of the most important considerations in implementing risk adjustment within a Medicaid Managed Care program. From Health Watch, January 2008, No. 57.

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: In this article, the author discusses the considerations and advantages of implementing an integrated enterprise risk management program for a health insurance company, and presents a summary of Aetna's experience with ERM as a case study.

Description: Article provides a market scan of recent state proposals for Medicaid work requirements as well as measures the impact to enrollment in different states.

Description: Key findings from a market research study which the SOA undertook as part of their strategic initiative: Untapped Opportunities for Actuaries in Health.

Description: This article begins with a comparison of the commercial risk adjuster to the exisiting Medicare model, and goes on to discuss why the existing strategies employed by health plans will not work in a risk adjusted environment. The article elaborates on the importance of diagnosis coding, controlling member mix, and care management in order to mitigate risks and gain from newly created opportunities.