Description: This article discusses the advantages, logistical concerns, and pricing formulas of implementing a TNHP, in which members pay less for treatment from providers who meet higher quality and cost-effectiveness standards.

Description: Using data to develop reserves for Incurred Prior Paid After and Incurred but Unpaid, Issue No. 38

Description: Actuarial appraisal and role of the actuary with regards to Health Insurance Mergers and Acquisitions. Issue No. 40.

Description: Hospitals, through consolidation and affiliations, gaining back negotiation strenght lost due to managed care in the 80s and 90s. Charges vary significantly by area and facility. Issue No. 46.

Description: Incorporating Pended Claims in Medical IBNR Estimates. Issue No. 45.

Description: Discussion of methods to estimate unpaid claim liability UCL for health plans. Includes traditional IBNR lag method and a lag method based on claims reported but not paid RBNP. Issue No. 45

Description: Recognizing an opportunity to help serve its members in this age of increased financial oversight, the Health Section of the Society of Actuaries commissioned a series of guides on the use of statistical techniques specifically geared for the work of health actuaries. From Health Watch Newsletter, January 2008, Issue No. 57.

Description: Analysis of diagnosis and pharmacy-based methods of health risk assessment. Issue No. 44.

Description: Applying Diagnosis-Based Predictive Models that use medical and pharmacy claims to measure expected costs for Group Underwriting. Issue No. 46.

Description: We highlight a new approach leveraging predictive analytics to identify high risk and rising risk opioid users for more effective screening and follow-up care.