Description: This article is intended to present a high-level review of a recently concluded research project (Mehmud & Yi, 2012) with the same title.

Description: Recognizing the importance of fortifying risk adjustment programs against selection based on nontraditional variables, the Society of Actuaries’ Health Section sponsored an in-depth study into the relationship of nontraditional variables with health costs. This report presents the results of this study.

Description: View the following report regarding Risk Scoring in Health Insurance: A Primer.

Description: The purpose of this study is to evaluate the predictive accuracy of the commercially available claims-based risk assessment tools under different sets of conditions and with different sets of available information.

Description: This hands–on, educational workshop will show you how to calculate dollar predictions, recalibrate risk weights and calculate various error metrics using sample members and corresponding risk adjustment output and actual claims.

Description: This report aims to expand our understanding by providing a methodology to quantify uncertainty in risk assessment.

Description: This article, an Honorable Mention Essay for the Society of Actuaries' Entrepreneurial Actuaries Section 2010 Papers Competition, is a discussion of the various issues relating to measurement of data in healthcare. The author presents “a light hearted & tongue-in-cheek take on how healthcare is typically measured, and an entrepreneurial vision for a better world.” Noting that typically data is summarized in deterministic models that produce point estimates for analysis and decision making, the author’s vision presented in the paper “is that of a central repository of actuarially modeled distributions that can either be used as benchmarks or adapted to an organization's experience.”

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: Full version of Health Watch News, Issue No. 56, September 2007.

Description: This article discusses the use of parametric distributions to model health care cost.