Description: Medicare Advantage and ACA

Description: The article explores how deeply the Affordable Care Act reduced the Medicare Advantage benchmark payment rates and quantifies how much of that reduction Medicare Advantage Organizations earned back through quality bonuses.

Description: The purpose of this project was to create a tool that would allow actuaries to derive an understanding of the evidence for medical technologies that are provided through health plans.

Description: The SOA is pleased to make available a research report providing insight and considerations for the actuarial profession in assessing the potential risk and opportunities of MACRA to both provider and payer organizations.

Description: A proposal to reform the health care provider payment system through: a national fee schedule, shifting more reimbursements to primary care providers, better integration of hospital & physician fees, evidence based care, pay for performance, and a better provider risk sharing mechanism.

Description: Introduction to population health, a collaborative discipline that seeks to leverage all the determinants of health personal behaviors, medical care and the public health infrastructure, as well as the social and economic context at the community and national level to maximize the health of populations.

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: Individual Market and ACA Products Actuarial rating principals

Description: The SOA is pleased to make available a research report providing insight and considerations for the actuarial profession in assessing the potential risk and opportunities of MACRA to both provider and payer organizations.