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: 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 of medical errors and their total measurable direct and indirect cost to the economy.

Description: Discussion of the separate and joint effects of obesity and diabetes on disability and mortality, and ways these effects can be used to improved insurance pricing and reserving, reverse the increasing rates of obesity and diabetes, and improve current projections of disability and mortality risks.

Description: This article describes methodologies for detection and deterrence of Medicare fraud. It also describes the validation of PRIDIT for fraud detection in Medicare.

Description: An economic analysis of bariatric surgery and health care costs supports the case for health plans to cover these procedures.

Description: A study of disability experience examines cost burden and degree of disability, and how these measures vary across different subpopulations.

Description: A closer look at family tier factor rating assumptions, and how well they reflect actual claim cost data.

Description: The authors explain big data and the potential uses of this information, especially as it is beginning to be adopted by the life insurance industry.

Description: We highlight a new approach leveraging predictive analytics to identify high risk and rising risk opioid users for more effective screening and follow-up care.