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: 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: Using Healthcare Claims Data to Create Actuarial Models.

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: Introduction to population health, a collaborative discipline that seeks to leverage all the determinants of health personal behaviors, medical care and the public health infrastructure, as well as the social and economic context at the community and national level to maximize the health of populations.