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: Overview of evolving industry trends and examples of how life insurers in Canada are innovating.

Description: Many executives are talking about predictive analytics uses in health insurance.

Description: Report from research project that reviewed and inventoried the range of quality and efficiency measures that demonstrate the performance of hospitals and physicians. Besides outlining key areas of consideration for quality and efficiency measurement, this report also describes future opportunities for actuaries and other health professionals interested in this evolving area. The inventory part of the report is in a separate document.

Description: Panel discussion about ways can insurance carriers and health care coalitions work together, what data are coalitions requesting from health carriers, how health carriers respond to those requests, and implications for health carriers.

Description: A new health insurance pricing model takes external market prices into account, as well as regulatory rate restrictions and other traditional pricing factors. Rather than being assumed at the outset, lapse rates emerge from the model, along with assessment spiral & loss ratio projections. Under the model optimal pricing strategy depends on whether the class being rated has a healthier than average mix of risks.

Description: Can we improve upon traditional methods of risk measurement and risk selection? Panelists discuss potential applications of predictive modeling, including individual underwriting, group rating and provider reimbursement. They focus on ways in which predictive modeling can be used to improve risk selection, experience rating and provider reimbursement. A session at the Health/Pension Spring Meeting held in New Orleans, Louisiana June 15-17, 2005. From the Record of the Society of Actuaries, Vol. 31, No. 2.

Description: This chapter focuses on creating practical models that aid in the prediction of the risk of readmission to a specific hospital within 30 days of discharge for Medicare patients, to aid in the identification and stratification of at-risk patients for hospitals considering building an intervention program in a cost-effective manner. For readers who wish to develop their own predictive model, a dataset is provided on the Actexmadriver.com website, and R code is provided in the appendix to this chapter.

Description: Research project that reviewed and inventoried the range of quality and efficiency measures that demonstrate the performance of hospitals and physicians. Besides outlining key areas of consideration for quality and efficiency measurement, this report also describes future opportunities for actuaries and other health professionals interested in this evolving area. The inventory part of this report is in a separate document.

Description: Presented at April 1986 Spring Meeting. This session discussion is about what analysis is effective in measuring recent medical care experience and are the projected cost-containment savings presented to plan sponsors being realized.