Description: This is a discussion of the medical loss ratio, the confusion and debate over the calculation method under the new MLR requirement, and the opportunities it presents to consulting actuaries.

Description: A proposal to address provider payment issues by gradually moving to accountable care organizations. Capitations would be risk-adjusted, non-capitated costs would be covered by hospitalization fund and stoploss, incentives for quality & effective preventive care would be tied to the amount remaining in the fund, and government involvement would be through incentives rather than mandate.