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: This article summarizes some of the operational considerations necessary to optimize the usefulness and impact of a predictive model, such as cross-functional support and involvement in model build, adequate training and reporting, and strategic model build.

Description: Many executives are talking about predictive analytics uses in health insurance.

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 discussion of permissible use and collection of genetic information for Health Risk Assessments and wellness programs under the Genetic Information Nondiscrimination Act of 2008.

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

Description: We highlight a new approach leveraging predictive analytics to identify high risk and rising risk opioid users for more effective screening and follow-up care.

Description: This article is a brief overview of what digital health is, how it is regulated, and who some of the big unicorns are.

Description: Review of a research project, co-sponsored by the SOA, which examined 83 organizations and over 150 programs that measure the quality and efficiency of hospitals and physicians.

Description: An analysis of health insurance cost and benefit trends using January 1, 2011 data from state employee medical plan renewals.