Description: Calculation of IBNR Reserves compares IBNP lag method to Incurred Claims PMPM method which produces lower Variance. Issue No. 46.

Description: This article summarizes what is new with the Academy health practice council. Issue No. 59

Description: Healthcare risk adjustment methodologies have become increasingly complex, largely due to the belief that complexity enhances accuracy. However, a disconnect exists between how healthcare risk is assessed and how payments are adjusted. This article explores the stark difference between measuring the accuracy of a risk assessment model at a member level, and that of a risk adjustment mechanism at the health plan level. I show that a highly simplified approach that does not use diagnosis codes can have similar accuracy on risk adjusted payments to models that do. These findings suggest that accuracy is not a barrier to developing simpler risk adjustment methodologies, which can improve payment accuracy and reduce the financial incentive for coding diagnoses.

Description: This article discusses the causes of the 1918 influenza pandemic, the reasons it occurred and the likelihood that it could happen again. In addition, the author discussed ways, in general, to model and manage risks that occur infrequently, yet have a significant impact.

Description: Key aspects of credibility formulas & modeling, experience data requirements Issue No. 37.

Description: NAIC Health Update. Issue No. 44.

Description: This corner serves to update the membership of some of the section’s milestones for this year, set the trajectory for 2009, and thank the many dedicated individuals and teams who made it happen. Issue No. 59

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 health care reform, Medicare, loss ratios, premium review, reinsurance, benefit and eligibility changes, exchanges, and risk based capital.

Description: This abstract describes a paper that describes two predictive models for hospital readmission rates using patient level data with specific patient information.

Description: Health insurance company assets and liabilities have evolved since the Patient Protection and Affordable Care Act (ACA) was signed into law in March 2010. The ACA fundamentally rearranged how commercial health insurance is funded by integrating federal premium subsidies and pass-throughs together with a marketplace interwoven with transfer payments among stakeholders. The impacts of these programs can be seen in specific accounting items on the balance sheets of health insurance companies over the past 10 years. Their emergence follows three primary trends: (1) balance sheet items tend to be larger and take longer to settle, (2) there are more interactions among items, and (3) the final settlement amounts are more uncertain.