Description: Identifying and submitting all appropriate ICD-9 diagnosis codes to CMS will result in a higher risk score for the member and increased payments to Medicare Advantage plans. Milliman's HCC prevalence study illustrates the significant variations in HCC prevalence rates by age/gender, geography, and population type and will assist plans in benchmarking the effectiveness of their own diagnosis code capture efforts.

Description: The September 2013 issue of the SOA Marketing and Distribution Section’s newsletter, NewsDirect

Description: Explores the open vs. closed systems debate with regards to actuarial modeling and exposes the over-simplification. Valuable for anyone who uses models.

Description: An economic analysis of bariatric surgery and health care costs supports the case for health plans to cover these procedures.

Description: Using the Cox proportional Hazards Model to improve underwriting debits and credits.

Description: A new health insurance pricing model takes external market prices into account, as well as regulatory rate restrictions and other traditional pricing factors. Rather than being assumed at the outset, lapse rates emerge from the model, along with assessment spiral & loss ratio projections. Under the model optimal pricing strategy depends on whether the class being rated has a healthier than average mix of risks.

Description: A closer look at family tier factor rating assumptions, and how well they reflect actual claim cost data.

Description: This article is to outline the new requirements for valuation rates in VM-22, highlighting key differences and example calculations to enhance understanding.