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: Article describes enhanced primary care models and provides citations on whether or not health care savings have been achieved.

Description: This article discusses new opportunities for states to waive certain marketplace requirements of the Patient Protection and Affordable Care Act. The article focuses on specific opportunities for states and the role that actuaries will play.

Description: The article reviews high-deductible health plans and poor reimbursement for mental health providers as being the root of 3 devastating problems facing the US.

Description: Updates on the efforts of the Academy’s health practice council. its work groups and task forces, to educate health care policymakers on issues including principles for reform, Medicare, the individual insurance market, and risk factors.

Description: Read the June 2017 issue of Health Watch, published by the Health Section. Practical information for actuaries, articles impact sections, section activities.

Description: This article contains a condensed summary and excerpt from the fourth white paper in the Commercial Health Care: What’s Next? series.

Description: Read the October 2018 issue of Health Watch, published by the Health Section. Practical information for actuaries, articles impact sections, section activities.

Description: What you need to know about risk scores to be competitive in the Medicare Advantage market.

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.