Description: The Health Plan Employee Data and Information Set 'HEDIS' is a set of standardized performance measures initially designed to enable purchasers of health care to evaluate and compare a managed care plan’s administrative performance. The National Committee for Quality Assurance, known as the NCQA, developed HEDIS in 1991. Since its introduction, HEDIS has become a widely used tool for measuring a broad array of health plan functions. This study evaluates the reliability and validity of HEDIS measures. It also reviews the usefulness of HEDIS as an indicator of health care quality.

Description: Analysis of possible mathematical relationships between hospital quality and hospital billed or allowed charges or other measures, using quality data as defined by the U.S. Department of Health and Human Services along with the Hospital Quality Alliance for their Hospital Quality Initiative.

Description: Discover the key components of value-based care (VBC) contracts and their impact on provider credibility. Learn about benchmarks, measurement period results, and the unique challenges providers face in managing insurance risk. Gain insights into reducing costs and aligning financial incentives in the US healthcare market.

Description: Yi-Ling Lin, FSA, MAAA, FCA, started the SOA’s Predictive Analytics Certificate Program to keep pace with the impact big data and predictive modeling is having on the health care industry

Description: Research project that reviewed and inventoried the range of quality and efficiency measures that demonstrate the performance of hospitals and physicians. Besides outlining key areas of consideration for quality and efficiency measurement, this report also describes future opportunities for actuaries and other health professionals interested in this evolving area. The inventory part of this report is in a separate document.

Description: New NCQA Quality Assessment Program for PPOs discussing rationale and performance meansurements, Issue No. 38.

Description: A proposal to address provider payment issues by gradually moving to accountable care organizations. Capitations would be risk-adjusted, non-capitated costs would be covered by hospitalization fund and stoploss, incentives for quality & effective preventive care would be tied to the amount remaining in the fund, and government involvement would be through incentives rather than mandate.

Description: Recap of Q&A sessions held to discuss the findings and methodology of a SOA study on the cost of the newly insured under the ACA.

Description: Discussion and Opinion on how randomness affects measurement of provider contracting risk-sharing agreements