Jeff Anderson

In addition to cutting benefits, Humana mentioned exiting certain counties and plans. This will create risk for Medigap insurers as the most costly MA members may be eligible for Medigap Guaranteed Issue rights. Loss ratios on GI business are often 15% higher than on the rest of the block. Some of the highlighted states can be more challenging for rate increases creating additional risk for the most competitively priced Medigap carriers.

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For June's Society of Actuaries YPAC podcast, join us for a conversation that journeys from the 1980’s to today, exploring how technology along with the actuarial profession has evolved. On this podcast, William Sayre, FSA (an actuary with decades of experience) will take Shang Xu, FSA (a Gen Z actuary) into the past, examine how the nature of actuarial work changed with the advancements in technology, how actuarial analysis became more sophisticated as products became more complex. https://lnkd.in/gsM2eYgp

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Record-breaking heat is becoming the new normal. How is the insurance industry coping? Milliman experts discuss the impact of extreme heat on workers' comp, property, and health insurance. Learn about their research and how the industry is preparing for the future. https://ow.ly/mxLG30sGrkB #extremeweather #insurance #riskmanagement

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Very interesting news on the GUIDE front from CMS (quoted below)- we'll see how this potentially affects interest and engagement in this model from MSSP ACOs. *However, GUIDE Respite Service claims will not be counted toward ACO expenditures, shared savings, nor benchmarking beginning in 2024 for the duration of the GUIDE Model. The GUIDE Respite Services will continue to be paid to GUIDE Participants but will not count as beneficiary identifiable final payments in the Shared Savings Program.*

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Will you be at the 2024 SOA Health conference next week? In a very timely session, we will be airing our grievances of the Medicare Star Rating program this Monday at our “Medicare Festivus—an Airing of Grievances on the Star Rating Program” session! I'm excited to host this session with Tim Murray, Suzanna-Grace Tritt, and Michael Bagel. And yes... we will be addressing the elephant in the room—the CMS Star Rating recalculations for bids that will still be open during our session! Inspired by Seinfeld's Festivus celebration, our panel will conduct a lighthearted airing of grievances related to the Medicare Star Rating program. We’ll use this interactive session to highlight key methodological challenges and, more importantly, brainstorm ideas that could drive sustainable, sound incentives and improved health equity. We’ll close out the session with a Star Rating themed take on Feats of Strength—may the best improvement idea win! Need to brush up on some of the recent rulings and Star Rating recalculations? Interested in the topic but not able to attend? I recently authored “Recalculating Medicare Advantage: Potential SCAN and Elevance ruling implications for MA stakeholders,” which looks at this ruling’s far-reaching implications for the Medicare Advantage landscape. Full white paper here: https://lnkd.in/gwjaY7G4 #SOAHealthConference #MillimanInsights #StarRatings #Medicare

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🌟 Medicare Advantage plans face significant challenges heading into 2025, and Julia Friedman's latest article delves into how MA-PD plans are adapting. Here are some of the challenges: 1️⃣ Cost pressures continue to grow: Rising medical costs and inflation are impacting the bottom line, pushing plans to get creative in cost management without compromising on quality. 2️⃣ Heightened regulatory scrutiny: CMS has implemented new rules for star ratings, pushing plans to boost quality measures while carefully managing costs—a fine balance that's critical to success. 3️⃣ Pharmacy benefit changes: The shifting pharmacy landscape, particularly around Part D, has been a big focus. Plans are exploring cost-effective drug management, especially with the rising cost of specialty drugs. 4️⃣ Enhanced benefits and flexibility: To stay competitive, plans are focusing on more than just healthcare, offering benefits like transportation and nutrition services to meet members' holistic needs. Whether you're working with Medicare Advantage plans or interested in healthcare policy, these insights shed light on the industry's future. Dive into the article in the comments for a closer look! #MedicareAdvantage #HealthcareTrends #MillimanInsights #Medicare

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