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: This is a brief report that summarizes recent changes in the prevalent medical loss ratio methodologies and also looks at some of the more recent experience of health insurers that filed medical loss ratio reports.

Description: In 2018, the Financial Accounting Standards Board (FASB) adopted significant revisions to the U.S. GAAP insurance accounting literature, via Accounting Standards Update (ASU) 2018-12. The title of ASU 2018-12 is “Targeted Improvements to the Accounting for Long-Duration Contracts,” and as a result a common acronym for ASU 2018-12 is LDTI (long-duration targeted improvements).

Description: There are many ways to actively utilize BE approaches – and implementing these important tools can help insurers in many ways.

Description: In 2018, the Financial Accounting Standards Board (FASB) adopted significant revisions to the U.S. GAAP insurance accounting literature, via Accounting Standards Update (ASU) 2018-12. The title of ASU 2018-12 is “Targeted Improvements to the Accounting for Long-Duration Contracts,” and as a result, a common acronym for ASU 2018-12 is LDTI (long-duration targeted improvements).