Description: This article is intended to present a high-level review of a recently concluded research project (Mehmud & Yi, 2012) with the same title.

Description: Identifying and submitting all appropriate ICD-9 diagnosis codes to CMS will result in a higher risk score for the member and increased payments to Medicare Advantage plans. Milliman's HCC prevalence study illustrates the significant variations in HCC prevalence rates by age/gender, geography, and population type and will assist plans in benchmarking the effectiveness of their own diagnosis code capture efforts.

Description: There are early indications of a six year cycle in ACA markets reminiscent of the traditional underwriting cycle.

Description: Considerations in the Development of Area Factors, Issue No. 38.

Description: Adjusting the 1985 NAIC Cancer Claim Cost Tables, a collection of morbidity tables, for Inflation and benefit changes Issue No. 34.

Description: Health claims are not normally distributed. Claims Forecasting can be improved by understanding the entire distribution of plausible values of future claims, for example knowing there is an 80% chance future claims are between $340 and $375 PMPM. Confidence intervals around our estimates allow us to understand for each range around the best estimate (for example +/- 1%) what is the probability that future claims will fall in that range. Quantile Regression is a mathematical technique where you can estimate any percentile of the claims distribution you are looking for as a function of demographics, diagnosis indicators, prior cost variables, or other significant predictors. You can see which coefficients are important at different parts of the distribution. Individual and group distributions can be constructed. There are numerous applications in pricing and underwriting, stop loss, provider profiling, ACO target setting, allocation of group risk charges based on volatility, discounting strategy, and experience analysis.

Description: This article is an overview of preliminary research on HSAs and Account-Based Health Plans. The summary reviews enrollment, health status, premiums and account information. From Health Watch Newsletter, September 2006, Issue No. 53.