Medicare Advantage risk scores – Are you competitive?status of their populations continues to be a primary key to their success. This article updates those ... member based on ICD- 10 diagnosis codes from health care claims. A member is assigned an HCC if an ICD- 10 ...
Description: What you need to know about risk scores to be competitive in the Medicare Advantage market.Hide
- Authors: Corey Berger
- Date: Oct 2018
- Competency: Results-Oriented Solutions>Actionable recommendations; Strategic Insight and Integration>Big picture view; Technical Skills & Analytical Problem Solving>Innovative solutions
- Publication Name: Health Watch
- Topics: Health & Disability>Health insurance; Health & Disability>Health risks; Health & Disability>Payment models; Social Insurance>Medicare
Projected Cost Analysis of Potential Medicare Pharmacy Plan Designssignificant current public policy issues in health care is the lack of coverage for prescription drugs ... prescription drug claims data provided by Medicare managed care contributors and contains experience for over 50 ...
Description: Research report sponsored by SOA to model and compare projected costs of different proposals for a Medicare prescription drug coverage plan. 3 types of costs are studied: net benefit cost estimates per member per month, continuance table data, and projected annual costs to the government over 10 years for two selected plan designs.Hide
- Authors: Lynette Trygstad, Timothy Feeser, Corey Berger
- Date: Jul 2003
- Competency: External Forces & Industry Knowledge; Leadership>Change management; Professional Values>Public interest representation; Results-Oriented Solutions>Actionable recommendations; Strategic Insight and Integration>Influence decisions; Technical Skills & Analytical Problem Solving>Problem analysis and definition
- Topics: Economics>Health economics; Health & Disability>Public financing - Health & Disability; Modeling & Statistical Methods>Forecasting; Public Policy; Social Insurance>Medicare; Technology & Applications>Analytics and informatics
Medicare Advantage Hierarchical Condition Categories: Targeting Chart ReviewsThe results are focused primarily on coordinated care plans (local HMOs, local PPOs and regional PPOs) ... Gender CHART 1 HCC Survey Results Coordinated Care Plan members (1) Includes All 70 HCCs (2) CHART ...
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.Hide
- Authors: Corey Berger, Eric P Goetsch
- Date: Jan 2011
- Competency: External Forces & Industry Knowledge>Actuarial methods in business operations; Results-Oriented Solutions>Actionable recommendations; Technical Skills & Analytical Problem Solving
- Publication Name: Health Watch
- Topics: Demography; Health & Disability>Health risks; Modeling & Statistical Methods>Data mining; Social Insurance>Medicare; Technology & Applications>Analytics and informatics