Description: What is the difference between a Single-Payer and Universal Health Care System, and how could the U.S. implement a system that would reduce the growth of medical costs while increasing quality.

Description: This analysis provides an overview of the functional components of the managed care system. It discusses the market forces underlying the United States’ system for health care financing and delivery and suggests how market forces impact the health care industry. The analysis focuses on societal goals for health care delivery and on managed care’s effectiveness in enabling achievement of those goals. The analysis develops and uses an innovative model developed to summarize the complex interplay among the many stakeholders, or participants, in the health care system. The model provides a framework for analysis of the many relationships among stakeholders. The analysis also highlights current issues in managed care, particularly the barriers that impede collaboration among stakeholders.

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?

Description: This session is about the details of the inception and implementation of the Oregon Health Plan. From Record of Society of Actuaries Vol. 18, No. 1B.

Description: Health Watch Newsletter, May 2006, Issue No. 52. This article presents information from a recently completed client-sponsored survey of hospital contracting best practices. Individual health plans were evaluated using a structured survey document. The primary objective of the survey was to identify best practices that the client sponsor could implement to improve its already better-than-average hospital contracting practices

Description: Part one of a two part series explores implementation issues for the Mental Health Parity and Addiction Equity Act of 2008 MHPAEA.

Description: This article focuses on the actuarial value calculator and the methodology used. It proposes potential future improvements to this model.

Description: Review of 2015 from perspective of the Health Section

Description: CHCS is a nonprofit policy center focused on improving American health outcomes, particularly for low-income people, including payment & delivery system reform.

Description: This article serves as an introduction to this issue of Health Watch and summarizes the content within.