Description: This session features a moderated discussion between medical professionals who are experts in long-term care. The presenters are outside the LTC insurance industry altogether, which will ensure that attendees receive a truly external perspective.

Description: Essay where payers desiring to optimize health gains per dollar spent should avoid “across the board” cost sharing, and instead implement a “value based” design that removes barriers/provides incentives to encourage desired behaviors for patients and providers.

Description: This paper examines the impact at Harvard Pilgrim Health Care of the introduction of specialty networks, shift to mail-order prescriptions, shifts to generic prescriptions, and product mix shifts to overall pharmacy trend. From Prescription Drugs Monograph, M-HB04-1.

Description: This project shows how to use agent-based models to simulate the behaviors of agents in complex health systems.

Description: A report analyzing the cost of care for deceased cancer patients over the last six months of life.

Description: Part one of a two part series explores implementation issues for the Mental Health Parity and Addiction Equity Act of 2008 MHPAEA.

Description: CHCS is a nonprofit policy center focused on improving American health outcomes, particularly for low-income people, including payment & delivery system reform.

Description: This is the second half of a two-part session regarding FASB Targeted Improvement (LDTI) to U.S. GAAP for long durational insurance contracts. Presenters of the session will discuss operational (e.g., data, systems, models and process, etc.) and financial issues concerning the implementation of the accounting changes. We will also discuss interpretation of the new standards specific to accident and health insurance. Throughout the session, we would like to encourage the audience to share their experiences.

Description: On average, contracts receiving their first star rating receive 3.20 stars, compared to existing or established contracts receiving 3.90 stars on average. This 0.70 disparity in quality ratings creates significant hardship on new contracts when this lower star rating decreases their payments in the following calendar year. This article explores the disparity in Medicare Advantage Star Ratings between contracts receiving their first star ratings (“New” contracts) and existing contracts, including: 1. Understanding what happens to Medicare Advantage Payments when contracts receive lower star ratings? – What is the Star Rating cliff and why does it matter to new contracts? 2. Explaining when a contract receives their first star rating and how much enrollment this requires – When does the Star Rating cliff occur? 3. Noting which specific star measures “New” contracts struggle with, including those contracts under large parent organizations, contracts with rapid growth, and all other new contracts. – How can my contract avoid the Star Rating cliff?

Description: What is the difference between a Single-Payer and Universal Health Care System, and how could the U.S. implement a system that would reduce the growth of medical costs while increasing quality.