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: When setting reserves, multiple methods are often used in the creation of the reserve estimate. Judgment is warranted to combine these different estimates into a final recommendation. This paper describes two techniques that can be used to combine these estimates that may result in better accuracy and lower variance.

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

Description: This article explores the disruptive applications of blockchain, an emerging technology, and its impact on the pharmacy benefit space, and pharmacy benefit managers (PBM).

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: Health Watch, Issue 79, December 2015, Health Watch

Description: This article is a brief overview of what digital health is, how it is regulated, and who some of the big unicorns are.

Description: An analysis of health insurance cost and benefit trends using January 1, 2011 data from state employee medical plan renewals.

Description: This paper outlines a framework for assisting a STARS manager in implementing a quantitative approach to prioritize stars measures for targeted intervention

Description: This article reviews underwriting and why it has remained unchanged for 50 years. The unhealthy lifestyles of Americans are examined. From Health Watch Newsletter, May 2006, Issue No. 52.