Description: Essay where payers desiring to optimize health gains per dollar spent should avoid “across the board” cost sharing, and instead implement a “value based” design that removes barriers/provides incentives to encourage desired behaviors for patients and providers.

Description: This paper examines the impact at Harvard Pilgrim Health Care of the introduction of specialty networks, shift to mail-order prescriptions, shifts to generic prescriptions, and product mix shifts to overall pharmacy trend. From Prescription Drugs Monograph, M-HB04-1.

Description: This review uses historical and contemporary sources to trace the growth of national health expenditures in the US from 1776 to 2026.

Description: This project shows how to use agent-based models to simulate the behaviors of agents in complex health systems.

Description: A report analyzing the cost of care for deceased cancer patients over the last six months of life.

Description: This is the second half of a two-part session regarding FASB Targeted Improvement (LDTI) to U.S. GAAP for long durational insurance contracts. Presenters of the session will discuss operational (e.g., data, systems, models and process, etc.) and financial issues concerning the implementation of the accounting changes. We will also discuss interpretation of the new standards specific to accident and health insurance. Throughout the session, we would like to encourage the audience to share their experiences.

Description: The medical and behavioral health care provider communities have long debated whether high-quality behavioral health care reduces medical costs. This presentation from Session 85PD of the SOA 1996 Colorado Springs Meeting reviews past studies relating to medical cost offsets and explores the potential magnitude of such design and delivery of medical and behavioral health care programs to encourage potential health care cost savings and to increase wellness. From the Record of the Society of Actuaries, Vol. 22, No. 2.

Description: This session discussion is about controls on utilization, eligibility control, pricing considerations, benefit design, mail order programs and physician dispensing. From Record of the Society of Actuaries Vol. 15, No. 1.

Description: This session discussion is about high cost claimants in medical benefit plans and how to control costs and anti-selection. From Record of the Society of Actuaries Vol. 15, No. 3B.

Description: On average, contracts receiving their first star rating receive 3.20 stars, compared to existing or established contracts receiving 3.90 stars on average. This 0.70 disparity in quality ratings creates significant hardship on new contracts when this lower star rating decreases their payments in the following calendar year. This article explores the disparity in Medicare Advantage Star Ratings between contracts receiving their first star ratings (“New” contracts) and existing contracts, including: 1. Understanding what happens to Medicare Advantage Payments when contracts receive lower star ratings? – What is the Star Rating cliff and why does it matter to new contracts? 2. Explaining when a contract receives their first star rating and how much enrollment this requires – When does the Star Rating cliff occur? 3. Noting which specific star measures “New” contracts struggle with, including those contracts under large parent organizations, contracts with rapid growth, and all other new contracts. – How can my contract avoid the Star Rating cliff?