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

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

Description: Python has become the fastest-growing major programming language in the world. It has surged in popularity over the last decade, following the development of its industry-leading capabilities in data science, machine learning and artificial intelligence, and it is now one of the most globally popular and widely used languages. In this article, I discuss some of the reasons for its popularity and explain why many actuaries and insurers have started using Python.

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: Using Healthcare Claims Data to Create Actuarial Models.

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.

Description: This article summarizes some of the operational considerations necessary to optimize the usefulness and impact of a predictive model, such as cross-functional support and involvement in model build, adequate training and reporting, and strategic model build.