Description: A rethinking of current provider reimbursement, focusing on incentives instead of simply cutting fees. The recommended 2-pronged approach would feature integrated provider organizations as well as evidence-based decision making organized around episodes of care.

Description: The ACA’s Medical Loss Ratio Provisions

Description: Introduction to the ACA @ 5 publication

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: This is a review of literature about the development and application of medical risk adjustment models. The current Medicare model, principal inpatient diagnosis cost group [PIPDCG] and proposed enhancements are the subject of many articles. Risk adjustment is used for both provider payment and performance measurement.

Description: This dissertation by Tia Sawhney will help you understand this issue and start measuring it, or start promoting equitable public policy.

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: CLASS Act and ACA