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

Description: Since health care reform has made accountable care organizations a hot topic, an SOA workgroup is addressing relevant questions, including provider risk under various ACO models, limitations of the Medicare model for motivating change in the health care delivery system, strategic priorities, attribution of members, meaurement, and the roles actuaries can play.

Description: This article compares July 1 renewal premium trends to January 1 renewal premium trends by benefit plan.

Description: A new initiative, Commercial Health Care: What’s Next, will focus on education and research for health actuaries regarding issues that remain with the ACA.

Description: Discusses various aspects of allowing a health insurance policy approved in one state to be sold in another state without the latter's approval or oversight.

Description: As private payers ponders the early adoption of genomic testing to guide treatment pathways, can personalized approaches to care prove financially sound?

Description: Collective Health plan sponsors found that concierge services and enhanced digital tools produced lower trend by helping members navigate more intelligently.

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?