Description: Risk adjustment is used to adjust the revenue stream to health insurers that sell ACA eligible plans and Medicare Advantage plans. This article compares and contrasts these risk adjustment programs.

Description: CLASS Act and ACA

Description: The healthcare industry is in the middle of extraordinary times. This article outlines the many forces driving this transformation, as well as various obstacles. This has both personal and business implications to health actuaries.

Description: Highlights of health related articles from the North American Actuarial Journal. A paper on health care reform and efficiency is published in a recent issue of the NAAJ.

Description: This article will consider several issues arising from ACO budgeting and pricing of stoploss coverage, including: 1) attribution of members; 2) claim carve outs; 3) ambiguous stoploss terms; 4) providers gaming the system and 5) credibility of data.

Description: This article describes the results of three years of work by Blue Shield of California to collaborate with hospitals and physician organizations to reduce cost and improve quality for commercial populations in targeted geographies.

Description: Taxes and Fees Introduced by the ACA

Description: A compilation of feedback from actuaries in the Health Section of the affects of the ACA.

Description: Summary of testimony by an AAA Board member before a congressional subcommittee, as an expert on risk assessment and adjustment, especially in relation to Medicare risk contracting and HMO payments. She recommended: mitigating the geographical region values, credibility weights for payments to health plans, carving out high cost claim segments, reengineering the ACR methodology, shifting AAPCC methodology from fee-for-service toward competitive bidding, and further projects to improve risk methods.

Description: This article discusses techniques used to create risk scores to help determine appropriate primary care panel sizes for a provider organization.