Health Insurance Risk Management

Journal Article

Development and Validation of Algorithms to Predict Activity, Mobility, and Memory Limitations Using Medicare Claims and Post-Acute Care Assessments

This study aims to create Medicare-based algorithms for predicting functional impairment, crucial for mortality and care use. Using machine learning and PAC data, memory and activity limitations were assessed with moderate success. While promising for PAC, broader older adult application is uncertain.

Commentary

Will Small Firms Self-Insure After Jan. 1, 2014?

Because of the ACA's regulations, some smaller employers with young and healthy workers are considering avoiding the purchase of health care coverage in the regulated market, opting instead to self-insure their employees.

Journal Article

Modeling Employer Self-Insurance Decisions After the Affordable Care Act

Self-insurance rates will increase among small firms only under the hypothetical situation that generous stop-loss policies are available to them after implementation of the ACA. Even if many small firms choose to self insure under this situation, it will not increase the premiums charged in the insurance exchanges by more than a few tenths of a percent.

Journal Article

Do Health Plans Risk-Select? An Audit Study on Germany's Social Health Insurance

This paper evaluates whether health plans in Germany's Social Health Insurance select on an easily observable predictor of risk: geography.

Journal Article

Household Portfolio Choices, Health Status and Health Care Systems: A Cross-Country Analysis Based on SHARE

Report

Ease Medicaid/SCHIP Eligibility Rules

This document explores how expanding Medicaid/SCHIP eligibility would affect health system performance along nine dimensions.

Report

Increase the Use of "Bundled" Payment Approaches

This document explores how increased use of bundled payment approaches would affect health system performance along nine dimensions.

Report

Require Employers to Offer Coverage

This document explores how requiring employers to offer health insurance (an employer mandate) would affect health system performance along nine dimensions.

Report

Require Individuals to Obtain Coverage

This document explores how requiring individuals to obtain health insurance (an individual mandate) would affect health system performance along nine dimensions.

Report

Create or Expand Access to Purchasing Pools

This document explores how creating or expanding access to purchasing pools would affect health system performance along nine dimensions.

Report

Hospital Pay for Performance

Researchers explore how hospital pay for performance would affect health system performance with respect to spending, patient experience, health, waste, consumer financial risk, coverage, and capacity.

Journal Article

The Prevalence of Formal Risk Adjustment in Health Plan Purchasing

Paper describes the prevalence of formal risk adjustment of payments made to health plans by Medicare, Medicaid, state governments, and private payers