Identifying future high-risk, or rising risk, patients can help healthcare organizations reduce population health costs through early intervention. In this paper, Milliman consultants Ksenia Whittal and Abigail Caldwell examine predictive models to determine whether an enhanced model can better identify individuals with rising risk relative to traditional prospective risk adjustment models. The authors also assess the capability of these models to select members whose costs will increase in the future year.
What patterns in plan design offerings have been seen in the marketplace during the first three years after the implementation of the Patient Protection and Affordable Care Act (ACA)? Individual market member projections exhibited a preference for lower-cost plans with health maintenance organization (HMO) plans and plans at the lower end of the allowable actuarial value (AV) range being the most popular. In contrast, small group membership projections shifted toward higher AV ranges within metallic tiers, which illustrates different preferences in the small group market.
By looking at trends in plan offerings, even at a macro level, insurers may be able to gain insight from emerging patterns in the market to help frame marketplace strategies in future years. Milliman’s Abigail Caldwell and Jordan Paulus offer more perspective in this paper.