Description: In the course of consulting engagements, actuaries almost always find they need one or more of the following resources: -Healthcare data, which may be at the individual patient level or on a particular population. -Health services research studies which describe, summarize, try to alter, or predict patients’ use of health resources. -Health policy information, which describe public or private actions which affect the access, cost and quality of medical care. This document describes the ever-changing resources and specifies where they may be obtained.

Description: As health care changes, actuaries need to be able to understand developments and work with users of health plan information. Actuaries also must be a credible source of data. This article describes the efforts of the Society of Actuaries Task Force on Alternative Care to determine the effectiveness of alternative or integrative medicine, including nontraditional techniques such as chiropractic, acupuncture, massage therapy, and nutritional counseling.

Description: Analysis of the impact of disease progression and treatment on life expectancy provides perspective on the long term costs to the health care system of chronic medical conditions.

Description: A discussion of issues to consider in selecting and contracting with a PBM.

Description: Details of an actuary’s project to help a local nonprofit agency improve its data analysis and customer service issues.

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: Part 1 of a 2-part series exploring implementation issues for the Mental Health Parity and Addiction Equity Act of 2008 MHPAEA. Part 2 addresses the new enforcement safe harbor, how the regulations could impact the business of behavioral health care and the impending decisions for payors, employers, providers, and insureds.

Description: In the article in The Actuary, April 1972 the writer referred to the 15-year study of aging by Professor Edman Palmore of the Center for the Study of Aging and Human Development of Duke University. His research indicated that work satisfaction was the best overall predictor of longevity and the second was overall happiness, reflecting a person's general satisfaction with his or her situation. The author discusses Work in America a paper written during the Nixon administration.

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: Discussion of recent developments in the taxation of noncoordinated benefits such as fixed indemnity, hospital indemnity, and specified disease insurance policies. Developments include a recent Chief Counsel Advice Memorandum and proposed triagency rulemaking that would impact non coordinated benefits.