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 paper reviews the geriatric literature to identify risk factors that could be used by insurers to identify existing or incipient frailty.

Description: This is an abstract for the paper, Analysis of Costs for a Chronic Disease with Acute High Cost Episodes by Marjorie Rosenberg and Philip Farrell.

Description: Successful healthcare reform: First, it must help that must keep healthy people healthy. Second, it must help people mitigate or eliminate the health-risks associated with unhealthy lifestyle behavior choices, and Third, it must ensure the provision of evidence-based care to those who are ill.

Description: The article describes the insurance industry's preparation for pandemic events and the public finance response.

Description: Presented at the Living to 100 Symposium, January 2011. This paper examines the relationship between the earliest stages of dementia—mild cognitive impairment—and mortality. Using data from long-term care insurance applicants, and linking this to the Social Security Master Death File, the authors focus on the classification results of two cognitive screens used at various times in the underwriting process. Applying the Cox Proportional Hazards Model as well as relative mortality ratio analysis, the authors show that the proportion of individuals classified as cognitively impaired have significantly higher relative mortality compared to those classified as cognitively intact.

Description: Presented at Living to 100 Symposium, January 2011. This paper first explores the current state and contributing causes of obesity. It then explores the mortality and health care costs of obesity. It ends with a discussion of its management.

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: The advent of machine learning algorithms has taken predictive analytics and risk scoring to a new level. From gradient boosting machines to k-nearest neighbors regression, the use of these techniques has gained significant traction in healthcare - including health systems like the Cleveland Clinic. This session will discuss the use of predictive analytics to go beyond just assessing the risk of a patient, and instead focus on prescribing a specific intervention of care. In practice, the recommendation of a care plan goes beyond just attributing a score to a patient. It provides physicians and care coordinators the most probabilistic options - e.g. referral to social worker, depression screening, weight-loss program - for positively impacting a patient's future healthcare outcome.

Description: This document provides an explanation of the Health Company Pandemic Modeling tool excel workbook and gives step by step instructions for companies to enter specific scenarios and assumptions.