Bests Review ranks Lewis and Ellis among the top health actuarial firms in the U.S. and Canada.
                                                                                             

If you're like me, the end of 2018 seems like ages ago and the New Year is off to a very fast start. There's a lot going on for actuaries in health, despite the government shutdown. As in previous editions of this newsletter, we're providing a high-level summary of news and fresh research. Email me at [email protected] with comments or questions.
Claim Costs
Measuring Movement in Volatile Markets
 

Trend analysis is not just a number-crunching exercise. Medical trend estimation is a complicated process, especially since passage of the Affordable Care Act. I teamed up with colleague Josh Hammerquist for this article in The Actuary, which describes new methods that can produce a clearer picture of what might happen in the future. Read it here.

Initiative 18 | 11
SOA and Kaiser Form Partnership    
New initiative will identify actionable steps to control US health costs
 
Enrollment in the Affordable Care Act     
 
Enrollment in the ACA is about 300_000 fewer than last year.

Prelimary figures from the the federal government show that about 300,000 fewer Americans signed up for 2019 coverage under the Affordable Care Act than last year. Several developments could have fueled the dip. Learn more. 
Battle Over Health Insurance
Judge Rules Health Law Unconstitutional
 
Another major court decision has cast doubt on the future of the ACA.
A long-awaited ruling by a federal judge in Texas has once again put the future of the Affordable Care Act in question, leaving insurance markets and legal scholars once more trying to predict what will happen next.   Read   
Risk Adjustment
New Mexico Lawsuit Challenges Methodology
 
Despite a legal challenge from a health care group in New Mexico_  CMS proceeded to issue a final risk adjustment rule for 2018.
Citing the need to maintain market stability, the Centers for Medicare & Medicaid Services issued a final risk adjustment rule for 2018 despite ongoing litigation involving the government's RA model.  More here. 
Surprise Medical Bills
U.S. Senate Convenes Bi-Partisan Committee
 
Lawmakers are planning legislation to prevent exhorbitant bills
Despite having insurance, many Americans are getting hit with high medical bills after a trip to the emergency room. Now a bi-partisan committee of U.S. senators is putting together a plan to address this growing problem.  Lean more.  
Office of the Actuary
Federal Government Reports Slower Growth   
 
CMS Office of the Actuary report on US healthcare spending
The growth of health care spending slowed in 2017 for the three largest goods and service categories: hospital care, physician and clinical services, and retail prescription drugs. Meanwhile a national poll found many Americans are delaying medical care because of the cost.   Learn about the report. 
Podcasts
Medicare Advantage Plans have evolved rapidly in the last 10 years, along with the regulatory structure surrounding them. This podcast explains how the annual Society of Actuaries' bootcamp on MA helps participants fully understand risk-adjustment as well as the bid development and pricing process.
  Listen. 
 
More on Medicare Advantage: The five star rating program of MA can have a big impact on insurer revenue. But the current landscape is rife with considerations that insurers must keep in mind, especially during the bid process. In this podcast learn how to boost star ratings and the additional revenue they bring. 
 
As a relatively new payment model, provider risk-sharing encompasses a broad body of knowledge. This podcast describes the annual two-day boot camp, sponsored by the Society of Actuaries, in which actuaries get intensive training on the methods and solutions they can use to help providers understand risks.   
 
David M. Dillon, FSA, MAAA, MS 
SVP & Principal
Lewis & Ellis Actuaries and Consultants
700 S. Central Expressway,  Allen, TX 75013
(972) 850-0850

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