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: 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: 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: Insurers are becoming increasingly involved in the development and marketing of prepaid health care service plans, or Health Maintenance Organizations HMOs. The article describes four different approaches for establishing capitation rates for HMOs 1. Integrated Budgeting Approach, 2. Inventory Approach, 3. Group Insurance Rating, and 4. Actuarial Approach.

Description: Using Healthcare Claims Data to Create Actuarial Models.

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

Description: A discussion of funding arrangements that can reduce the costs of providing medical coverage through lower reserves or state tax savings, instead of through cutting benefits.