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: The ACA’s Medical Loss Ratio Provisions

Description: As actuaries in health care, we spend most of our time focused on reviewing claims, enrollment and clinical data. That information is captured while patients are in health care facilities. Yet most people spend only a small fraction of their time in these facilities. This article explores what types of data are available to actuaries the provide a more holistic view of the member so that a members physical and emotional needs, the social determinants of health can be taken into consideration along with their clinical needs. Two uses cases are presented so actuaries can see how these types of analyses can be leveraged to improve clinical, operational, and financial performance of risk bearing health entities. Understanding the customer (member) not just the patient enables actuaries to provide new insights and values to our stakeholders across a wide range of business and risk applications.

Description: The International Actuarial Association Health Section, the Society of Actuaries International Section, and American Academy of Actuaries (AAA) published the report “International Health Care Funding 2020”. This article highlights the features of the report.

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

Description: This article provides an in-depth discussion of how subsidies are an integral part of affordability for individual health insurance under the Affordable Care Act, and, ultimately, impact the viability of the market.

Description: What is the difference between a Single-Payer and Universal Health Care System, and how could the U.S. implement a system that would reduce the growth of medical costs while increasing quality.

Description: Presented at April 1985 Spring Meeting. Addresses questions being asked about the future of health care financing: 1. Will the traditional insurer-based program be the predominant financing mechanism in the future? 2. Will Preferred Provider Organizations, Health Maintenance Organizations or other mechanisms displace current approaches? What additional institutions will enter this field? 3. What major factors will determine the outcome?

Description: Affordable Care Act and Payment Reform

Description: Discussion and Opinion on how randomness affects measurement of provider contracting risk-sharing agreements