Description: Summary of Medicaid encounter data, including how it is collected by health plans, transferred to state databases, used by states, and ultimately sent to CMS. The status of the CMS T-MSIS project is discussed, as well as the future of Medicaid encounter data as a source of information for many stakeholders.

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: The author discusses her time working in LTCI and how her views regarding the effect of volatility and uncertainty have evolved over this time.

Description: This paper proposes a new method to price the longevity risk premia in order to tackle the pricing obstacle. Based on the equivalent utility pricing principle, our method obtains the minimum risk premium required by the longevity insurance seller and the maximum acceptable risk premium by the longevity insurance buyer.

Description: this article provides an overview of coverage and claim trends for managed care medical excess of loss insurance and reinsurance programs. it addresses features such as deductible, maximum benefit, inside limits , comprehensive versus non- comprehensive , and claims by diagnosis for commercial , Medicare and Medicaid risk. It also reviews cost containment support programs for catastrophic claims .

Description: Analysis of the projected impact of the Affordable Care Act on Medicare Part C revenue over 2014 through 2017, with background on recent historical revenue trends. The analysis is largely based on CMS published data, with trend analysis based on the Medicare Trustees report and author's assumptions.

Description: The US Preventive Services Task Force (USPSTF) requires that essential benefits include "intensive behavioral counseling" for overweight or obese individuals with any other cardiovascular disease risk factors. These requirements can be met through online digital programs that meet the clinical standards of the recognized Diabetes Prevention Program (DPP). This new branch of medicine-digital therapeutics-holds the key to delivering lifesaving interventions to those who need them the most. Omada Health’s Prevent is an example of one innovative product which has successfully translated behavioral interventions like DPP to an online setting. Sean Duffy focused on small-group support, personal health coaching, personalized and engaging design, DPP curriculum adherence and progress tracking-leveraging unique aspects of technology to enhance key elements of successful behavioral interventions. These scalable solutions can bene fit multiple players within the managed care ecosystem and are being seeded by health plan venture investments to help bend the cost curve across the industry.

Description: This paper presents an approach to analyzing continuing care retirement community [CCRC] data, and demonstrates the methods using data from a large CCRC. It is assumed that residents make transitions among a number of states that represent the levels of care required by residents. There is randomness associated with both the transition times and the states entered at these times. The model is conveniently characterized in terms of transition intensity functions, which represent the instantaneous rates of transition between pairs of states.

Description: Report from research project that reviewed and inventoried the range of quality and efficiency measures that demonstrate the performance of hospitals and physicians. Besides outlining key areas of consideration for quality and efficiency measurement, this report also describes future opportunities for actuaries and other health professionals interested in this evolving area. The inventory part of the report is in a separate document.

Description: This session from the 2003 SOA Orlando Meeting addresses long-term care reinsurance, annuity reinsurance - dealing with the shift from variable to fixed, the global life and life reinsurance market, personal accident reinsurance and the catastrophe market. From the Record of the Society of Actuaries, Volume 29, No. 3.