Description: Rick Foster, chief actuary at the Centers for Medicare & Medicaid Services discusses public policy

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: Read the August 2020 issue of Health Watch published by the Health Section. Newsletters provide practical information for the working actuary, articles on trends that impact sections and news about section activities.

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.

Description: NAIC Health Update. Issue No. 44.

Description: This article profiles Rajiv Nundy's career. From Health Watch Newsletter, January 2008, Issue 57.

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: A look at the career and accomplishments of Julia Philips, the only health actuary employed at the Minnesota Department of Commerce. She believes her learn-by-doing attitude has allowed her to build a career she enjoys, which includes her to work to promote consumer protection, volunteer with many organizations, and implement health reform.

Description: Article presents a summary of the AAA's Health Practice Council Activities including input for PPACA and various work groups.

Description: Risk adjustment is used to adjust the revenue stream to health insurers that sell ACA eligible plans and Medicare Advantage plans. This article compares and contrasts these risk adjustment programs.