Predictive analytics can improve medical outcomes by identifying patients needing medical interventions. Population segmentation is a common method used to identify such patients. Individuals are grouped into cohorts to help improve the quality of their care. In this paper, Milliman’s Jordan Paulus and Nick Creten explore four common methods for population segmentation: cost cohort segmentation, condition cohort segmentation, utilization cohort segmentation, and social cohort segmentation.
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.
The federal risk adjustment program is set up to transfer funds from payers with lower-risk populations to those with higher-risk populations. This was done to “level the playing field” among insurers by removing the incentive to attract only healthy individuals.
Milliman consultants Mary van der Heijde and Jordan Paulus offer some considerations for carriers in their paper “Risk adjustment: Overview and opportunity: Top 10 notable issues related to the federal risk adjuster.”