Description: A proposal to reform the health care provider payment system through: a national fee schedule, shifting more reimbursements to primary care providers, better integration of hospital & physician fees, evidence based care, pay for performance, and a better provider risk sharing mechanism.

Description: A proposal to address provider payment issues by gradually moving to accountable care organizations. Capitations would be risk-adjusted, non-capitated costs would be covered by hospitalization fund and stoploss, incentives for quality & effective preventive care would be tied to the amount remaining in the fund, and government involvement would be through incentives rather than mandate.

Description: This article is based on a third party administrator study and explores the relationships between family structure, spare capacity and health care utilization.

Description: An actuarial model that provides financial incentives to providers to offer patients an approach that can reverse chronic disease and reduce health care costs

Description: An overview of the issues behind reimbursing providers on a bundled or packaged basis. The article presents the potential advantages offered by the proponents as well as the criticisms and obstacles to implementing this type of payment system.

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: Summary of common mistakes made by actuaries developing ACA rate filings. Outlines correct approach to ACA rate filing process. Suggests Peer Review process.

Description: This paper will examine why CSR defunding produces pricing uncertainty and how regulators can alleviate these risks when insurers price 2020 premiums.

Description: Read the November 2016 issue of Health Watch published by the Health Section. Newsletters provide practical information for the working actuary, articles on trends that impact sections and news about section activities.