Health risks
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Comparison of Risk Adjustment Programs—California Medicaid Managed Care Versus CMS Medicare Advantage, PART II
Risk Adjustment (RA) is a key component for CMS Medicare Advantage program and California Medicaid Managed Care program. While both RA programs follow generally accepted basic principles, their underlying methodologies and assumptions are quite different. Due to recent events, such as COVID-19 Public Health Emergency and Medicaid redetermination delay and restart, it adds complexity to Risk Adjustment. This is a hot topic in the industry and has significant impact to health plans. Keeping current with Risk Adjustment program changes and understanding the commonalities and differences of these two government Risk Adjustment programs is important to our health actuaries. This article compares and contracts these two risk adjustment programs’ methodology and assumptions as well as special considerations due to serving different populations. This is Part II of the two articles on this topic. -
Transforming Group Underwriting Using Artificial Intelligence and Machine Learning
A review of opportunities for using machine learning and artificial intelligence in group health underwriting including cost predictors and predicting behavior and decisions.
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