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

Description: A guide to the protocols and rules necessary to ensure an accurate savings comparison when using an historical claims repricing in the PBM RFP process.

Description: This article serves as an introduction to this issue of Health Watch and summarizes the content within.

Description: This article is an interview with Paul Stordahl on his role in the actuarial profession.

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: Read the November 26 2019 issue of Health Watch, published by the Health Section. Practical information for actuaries, articles impact sections, section activities.

Description: Cost sharing reduction (CSR) payments are offered to low-income individual insurance buyers under the ACA. After October 2017, the difference in costs between the standard silver plan and CSR variants were defunded. To cover the costs of defunding, insurers have increased rates either through "broad loading" or "silver loading." States are approaching this adjustment differently, which is leading to some interesting differences between states. This article will review these differences.

Description: This article attempts to make a modest contribution to the dialogue on the potential and risks associated with novel treatments such as cell & gene therapies. With a fast-expanding roster of what are believed to be one-time treatments at ever increasing price points aimed at curing a wider swatch of the population, they are as much a source of relief for patients stuck in medical limbo, as they are a source of anxiety for payers.

Description: Presents a step-by-step methodology for calculating confidence intervals for IBNR estimates derived using the Averaqe PMPM method. It is a companion article to the January 2023 Health Watch article presenting the Average PMPM method for generating point estimates of IBNR with zero claims runout.