Description: Health claims are not normally distributed. Claims Forecasting can be improved by understanding the entire distribution of plausible values of future claims, for example knowing there is an 80% chance future claims are between $340 and $375 PMPM. Confidence intervals around our estimates allow us to understand for each range around the best estimate (for example +/- 1%) what is the probability that future claims will fall in that range. Quantile Regression is a mathematical technique where you can estimate any percentile of the claims distribution you are looking for as a function of demographics, diagnosis indicators, prior cost variables, or other significant predictors. You can see which coefficients are important at different parts of the distribution. Individual and group distributions can be constructed. There are numerous applications in pricing and underwriting, stop loss, provider profiling, ACO target setting, allocation of group risk charges based on volatility, discounting strategy, and experience analysis.

Description: Issue No. 36. Issues relating to Provider Sponsored Organizations PSOs contracting with HCFA to sponsor Medicare + Choice. Article discusses revenue and the addition of non-Medicare covered benefits.

Description: Why health care inflation exceeds the Consumer Price Index CPI due to tax implications. Issue No. 37.

Description: How benchmarking actual performance to a published source is a useful tool in assessing the value added by a particular program or MCO, Issue No. 38.

Description: Implications of the Final Health Privacy Rule HIPAA with regards to underwriting, renewing, rating, reserving, reinsurance and acquisitions. Issue No. 40.

Description: Full version of Health Section News, June 2002, Issue No. 46.

Description: Chairperson’s Corner Variablility of Health Costs by John P. Cookson from Health Section News, August 2003, Issue No. 46.

Description: Calculation of IBNR Reserves compares IBNP lag method to Incurred Claims PMPM method which produces lower Variance. Issue No. 46.

Description: Terrorism risk and catastrophe reinsurance. From Health Section News, August 2003, Issue No. 46.

Description: Health Section News, August 2005, Issue 50 which discusses the effective management of prescription drug utilization and coverage that continue to represent one of the biggest challenges facing insurers, managed care organizations, employers and consumers alike.