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: 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.

Description: The editors preview the articles in the February 2010 issue of Health Watch.

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: An excerpt from a presentation at the 2014 Living to 100 Symposium, this article describes an open-source model for use by actuaries attempting to estimate future health benefit costs, discusses its strengths and limitations, and projects that spending for those age over 65 will take more than $13 trillion by 2055, about 50 percent of total medical expenditures.

Description: Discussion that developing credibility factors for group health insurance can be accomplished empirically through the use of stochastic models with appropriate parameters and fairly readily obtainable data, without the need for unrealistic assumptions.

Description: This article discusses the advantages, logistical concerns, and pricing formulas of implementing a TNHP, in which members pay less for treatment from providers who meet higher quality and cost-effectiveness standards.

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

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