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Medicare Advantage Hierarchical Condition Categories: Targeting Chart Reviews
Medicare Advantage Hierarchical Condition Categories: Targeting Chart Reviews Identifying and submitting all appropriate ICD-9 diagnosis codes to CMS will result in a higher risk score for the ...- 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
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Modeling Anti-selective Lapse and Optimal Pricing in Individual and Small Group Health Insurance
Modeling Anti-selective Lapse and Optimal Pricing in Individual and Small Group Health Insurance A new health insurance pricing model takes external market prices into account, as well as ...- Authors: D Wei
- Date: Feb 2010
- Competency: External Forces & Industry Knowledge>Actuarial methods in business operations; Results-Oriented Solutions>Actionable recommendations; Technical Skills & Analytical Problem Solving>Incorporate risk management
- Publication Name: Health Watch
- Topics: Economics>Health economics; Health & Disability>Health risks; Modeling & Statistical Methods; Technology & Applications>Analytics and informatics
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Health Section Issues New IBNR Study
Health Section Issues New IBNR Study Summary of the health section council’s research project to assess the accuracy of commonly used IBNR estimation methods over a wide range of scenarios.- Authors: Steven Siegel, Cabe Chadick
- Date: Feb 2010
- Competency: External Forces & Industry Knowledge>Actuarial methods in business operations; Results-Oriented Solutions>Assess decision effectiveness; Technical Skills & Analytical Problem Solving>Process and technique refinement
- Publication Name: Health Watch
- Topics: Actuarial Profession>Standards of practice; Financial Reporting & Accounting; Health & Disability>Health care; Modeling & Statistical Methods>Modeling efficiency
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Letter from the Editors
Letter from the Editors The editors preview the articles in the February 2010 issue of Health Watch. Global markets;Health reserves;Solvency II; 9532 2/1/2010 12:00:00 AM ...- Authors: Grady Catterall, Mary Kindel Van der Heijde
- Date: Feb 2010
- Competency: External Forces & Industry Knowledge>Actuarial methods in business operations; Leadership; Strategic Insight and Integration>Big picture view
- Publication Name: Health Watch
- Topics: Actuarial Profession>Professional associations; Global Perspectives; Modeling & Statistical Methods
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To Err is Human, To Estimate is Actuarial
To Err is Human, To Estimate is Actuarial Realizing the impact of medical errors on the U.S. health care system, the Health Section commissioned a research project to measure the annual frequency ...- Authors: Steven Siegel
- Date: Sep 2010
- Competency: External Forces & Industry Knowledge>Actuarial methods in business operations; Technical Skills & Analytical Problem Solving
- Publication Name: Health Watch
- Topics: Actuarial Profession>Academic partnerships; Economics>Health economics; Experience Studies & Data; Modeling & Statistical Methods>Data mining
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Modeling the Cost of Medical Care for the Elderly
Modeling the Cost of Medical Care for the Elderly An excerpt from a presentation at the 2014 Living to 100 Symposium, this article describes an open-source model for use by actuaries attempting ...- Authors: Thomas Getzen
- Date: Jan 2014
- Competency: External Forces & Industry Knowledge>Actuarial methods in business operations; External Forces & Industry Knowledge>Actuarial theory in business context; Technical Skills & Analytical Problem Solving>Process and technique refinement
- Publication Name: Health Watch
- Topics: Long-term Care>Medical expenses; Modeling & Statistical Methods>Estimation methods
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Developing Group Health Credibility Factors through Stochastic Modeling
Developing Group Health Credibility Factors through Stochastic Modeling Discussion that developing credibility factors for group health insurance can be accomplished empirically through the use ...- Authors: John N Albert
- Date: Jan 2014
- Competency: External Forces & Industry Knowledge>Actuarial methods in business operations
- Publication Name: Health Watch
- Topics: Health & Disability>Health insurance; Modeling & Statistical Methods>Stochastic models
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Design and Pricing of Tiered Network Health Plans
Design and Pricing of Tiered Network Health Plans This article discusses the advantages, logistical concerns, and pricing formulas of implementing a TNHP, in which members pay less for treatment ...- Authors: Peter Horman
- Date: May 2009
- Competency: External Forces & Industry Knowledge>Actuarial methods in business operations; Results-Oriented Solutions; Strategic Insight and Integration>Effective decision-making; Technical Skills & Analytical Problem Solving>Process and technique refinement
- Publication Name: Health Watch
- Topics: Economics>Health economics; Health & Disability>Health care quality; Modeling & Statistical Methods
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Bariatric Surgery Holds Promise for Patients and for Payors
Bariatric Surgery Holds Promise for Patients and for Payors An economic analysis of bariatric surgery and health care costs supports the case for health plans to cover these procedures. Health ...- Authors: John Dawson, Pierre-Yves Cremieux, Arindam Ghosh
- Date: Jan 2011
- Competency: External Forces & Industry Knowledge>Actuarial methods in business operations; Results-Oriented Solutions>Actionable recommendations; Technical Skills & Analytical Problem Solving>Problem analysis and definition
- Publication Name: Health Watch
- Topics: Economics>Health economics; Experience Studies & Data; Health & Disability>Health risks; Modeling & Statistical Methods>Data mining
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Rethinking Family Tiers
Rethinking Family Tiers A closer look at family tier factor rating assumptions, and how well they reflect actual claim cost data. Assumptions;Family coverage;Health care costs; 25712 1/1/2011 12: ...- Authors: Kristi Bohn
- Date: Jan 2011
- Competency: External Forces & Industry Knowledge>Actuarial methods in business operations; Results-Oriented Solutions>Actionable recommendations; Technical Skills & Analytical Problem Solving>Problem analysis and definition
- Publication Name: Health Watch
- Topics: Modeling & Statistical Methods>Data mining; Technology & Applications>Analytics and informatics