Description: Article presents new course readings that cover hot health topics that will expand actuarial expertise in the Health Systems practice area.

Description: Article is about community rating and risk adjustment including possible disadvantages for healthy experience-rated or self-insured groups.

Description: The author gives his opinions of the cause of the health care financing crisis and ever increasing health care costs.

Description: This editorial reviews the benefits of managed care, notes the public pressure to relax controls around this system and the expected cost impact of doing so.

Description: This study was sponsored by the Society of Actuaries Health Section. This paper explores the relative significance of aging as a determinant of financial cost of health care beyond age 50, with particular attention to the effect for ages 65 and older. The paper presents concepts of aging factors and aging curves, which define relative values between ages for utilization or cost of health care services. General conclusions are drawn from Medicare data that utilization and cost differ by age, but that aging factors vary across services and may be less significant at very old ages. The author then turns to the question of measuring the significance of an aging curve assumption and what accuracy is lost in the simpler alternative of a single value across an age range.

Description: This is one of a series of SOA-sponsored papers on the subject of Evaluating the Results of Care Management Interventions. This paper addresses the theory of measurement design and provides a practical evaluation of the most common designs for the practitioner.

Description: Summary of results of a 2010 Health Section survey of actuaries and Medicare population, on ways to bend the cost trend curve downward. Issues included transparency, quality measures, fraud and abuse, provider payment, malpractice, medical errors, consumer education, and the pros and cons of employer-sponsored coverage.

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: Susan Dentzer, editor-in-chief of Health Affairs, discusses health care and health policy.

Description: The article is a case study of various actuarial concepts invovled in the design and implementtion of the AQC - a global budget provider payment arrangement implemented by Blue Cross Blue Shield of MA.