Description: Summary of Medicaid encounter data, including how it is collected by health plans, transferred to state databases, used by states, and ultimately sent to CMS. The status of the CMS T-MSIS project is discussed, as well as the future of Medicaid encounter data as a source of information for many stakeholders.

Description: Essays show a new system that will encompass minor changes to the current health insurance system, it will allow consumers to sign up for Federal Employees Health Benefit Plan and be administered like Medicare but with more benefits and emphasis on preventive care.

Description: A Regulatory Perspective on Rate Review Before and After the Affordable Care Act

Description: Essential Health Benefits and Actuarial Value

Description: Medicare Advantage and ACA

Description: Individual Market and ACA Products Actuarial rating principals

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.

Description: In the course of consulting engagements, actuaries almost always find they need one or more of the following resources: -Healthcare data, which may be at the individual patient level or on a particular population. -Health services research studies which describe, summarize, try to alter, or predict patients’ use of health resources. -Health policy information, which describe public or private actions which affect the access, cost and quality of medical care. This document describes the ever-changing resources and specifies where they may be obtained.