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: Article explores why many integrated delivery systems are struggling and what actions they need to take to succeed.

Description: This article discusses the legislative summary of the changes that will occur with the new Medigap policies, which will be effective on or after June 1, 2010. Issue No 60

Description: The Health Section Council HSC of the Society of Actuaries approved and funded a project to study the cost impact on plan sponsor retiree pharmacy costs when Medicare Part D is implemented in 2006. Actuarial & Health Care Solutions, LLC AHCS was retained by HSC to perform the project. This report provides estimated savings for several of the options that will be available to plan sponsors after implementation of the Medicare prescription drug program.

Description: This article discusses planning for the changes that will occur with the new Medigap policies, which will be effective on or after June 1, 2010. Issue No. 60

Description: This article takes a closer look at Medicare Part D Coverage and the types of payment demonstration payment of the federal reinsurance amountFlexible Capitation, Fixed Capitation, MA Rebate. Issue No 60

Description: Changes introduced by various Medicare Alternative Payment Models and the Medicare Access and CHIP Reauthorization Act (MACRA) have accelerated an existing market trend of shifting some of what has traditionally been considered “insurance risk” to providers. The Provider Risk Sharing Boot Camp will give attendees deeper insights into methods, current thinking, and alternative solutions that actuaries can use to help providers understand and manage the financial and actuarial risks that they are taking, many for the first time.

Description: Chairperson's corner for January 2020 In the Public Interest.