Description: This article examines the costs of mental health parity, presents the primary drivers of cost increases from legislation and shows evidence the initial cost projections were too high. From Health Section News, March 2005, Issue No. 49.

Description: With many pharmacy benefit plans now considering whether to add a 4th tier for high priced specialty drugs, review and discussion also needs to be given to the other end of the pharmacy cost spectrum to see how costs can be reduced by promoting lower cost over-the counter OTC drugs. From Health Watch News, September 2006, Issue No. 53.

Description: This article outlines what the author learned from the Sixth Annual Quality Colloquium at Harvard. From Health Watch, January 2008, Issue No. 57.

Description: ACA risk adjustment is intended to "bridge the gap" between allowed rates and actuarial rates. If risk adjustment methodology is not bridging that gap & becomes an additional input to pricing formulae, it is not serving its intended purpose.

Description: As actuaries in health care, we spend most of our time focused on reviewing claims, enrollment and clinical data. That information is captured while patients are in health care facilities. Yet most people spend only a small fraction of their time in these facilities. This article explores what types of data are available to actuaries the provide a more holistic view of the member so that a members physical and emotional needs, the social determinants of health can be taken into consideration along with their clinical needs. Two uses cases are presented so actuaries can see how these types of analyses can be leveraged to improve clinical, operational, and financial performance of risk bearing health entities. Understanding the customer (member) not just the patient enables actuaries to provide new insights and values to our stakeholders across a wide range of business and risk applications.

Description: This article is intended to inform readers about the current state of mental health and health care in the US, as were it's heading moving forward.

Description: Estimating IBNR from Authorized Bed Days. Issue No. 40.

Description: Considerations in the applications of Predictive Modeling for health care management. Issue No. 47.

Description: Of the three issues in health care—coverage, financing, and cost—the overriding issue is holding down the growth in health care costs while simultaneously improving the quality of care. This article introduces new concepts for reducing cost and increasing quality. From Health Watch, January 2008, Issue No. 57.

Description: This article talks about forging relationships between Health actuaries and CMS. Issue No. 60