An International Discussion on Risk Adjustment
January 27, 2016
The European Risk Adjustment Network (RAN) is an informal annual gathering of risk adjustment experts (academic and governmental) from several European countries and Israel that meets to exchange ideas on the latest research in applied risk adjustment. In its 15th annual session in Solothurn, Switzerland, the RAN included participants from Ireland, Belgium, the Netherlands, Germany, Israel, and Switzerland, plus a U.S. delegation. With over 20 years of experience with risk adjustment, the Netherlands, Germany, and Switzerland provide relevant lessons to other countries that have evolved a risk adjustment mechanism for their health care programs.
The Academy’s Health Practice International Committee and the International Actuarial Association Health Section (IAAHS) offered a webinar that provided members with a look at the information coming out of this annual meeting. The panelists provided a report on the discussions, including specific reports from each country in Europe that can be applied to the Affordable Care Act’s (ACA) risk adjustment program implemented in the U.S. The panelists discussed the application of the ACA risk adjustment to the California individual insurance market.
- John Bertko, MAAA, FSA, chief actuary, Covered California
- John Hsu, MD, MBA, MSCE, director, Program for Clinical Economics and Policy Analysis, Massachusetts General Hospital, and associate professor, Medicine and Health Policy, Department of Health Care Policy, Harvard Medical School
- April Choi, MAAA, FSA, member, Academy Health Practice Council
ABOUT OUR PRESENTERS
John Bertko is currently an independent actuarial consultant working as the Chief Actuary with Covered California (California’s Insurance Marketplace) and was the Director of Special Initiatives and Pricing in the Center for Consumer Information and Insurance Oversight at the Centers for Medicare and Medicaid Services (CMS), retiring from this position as of January 31, 2014. He served as a senior actuarial advisor on various private insurance initiatives, including risk adjustment, insurance programs and insurance oversight activities. He served on the Massachusetts Connector Board from October 2014 to March 2015. He formerly was a Senior Fellow at the LMI Center for Health Reform, Adjunct Staff at RAND, a Visiting Scholar at the Brookings Institution, a Visiting Scholar at the Center for Health Policy at Stanford, and the retired Chief Actuary of Humana Inc., where he managed the corporate actuarial group and directed work by actuarial staff for Humana’s major business units, including developing Part D, Medicare Advantage, and consumer-driven health care products. He has extensive experience with risk adjustment and has served in several public policy advisory roles. He serves on the panel of health advisors for the Congressional Budget Office and completed a 6-year term on the Medicare Payment Advisory Commission (MedPAC). He served the American Academy of Actuaries as a board member from 1994 to 1996 and as vice president for the Health Practice Council from 1995 to 1996. He is a Fellow of the Society of Actuaries and a Member of the American Academy of Actuaries. He has a B.S. in mathematics from Case Western Reserve University.
Dr. John Hsu is the director of the Program for Clinical Economics and Policy Analysis within the Mongan Institute, Massachusetts General Hospital, and an Associate Professor of Medicine and of Health Policy, Department of Health Care Policy, Harvard Medical School. He studies innovations in health care financing and delivery, and their effects on medical quality and efficiency. In his work, he primarily uses large automated and electronic health record data sets, often exploiting natural experiments from both clinical and behavioral economics perspectives. Dr. Hsu’s current work focuses on the interplay between benefit design and delivery system integration. He has collaborated closely with policy makers and organizational decision makers to help implement changes based on his research findings. He has been continually funded by multiple R01 grants (including from the Agency for Healthcare Research and Quality and the National Institutes of Health).
ABOUT OUR MODERATOR
April Choi is an actuarial executive with over 35 years of health care experience. She is currently an independent actuarial consultant based in California.
April has been the chairperson of the International Actuarial Association Health Section since 2014. She was the chairperson of the American Academy of Actuaries' Health Practice International Task Force from 2009 to 2014. She is a member of the American Academy of Actuaries' Health Practice Council, chairperson of the Public Program Committee, and she has served on many of the American Academy of Actuaries' health care reform workgroups. She is a fellow of the Society of Actuaries and a member of the American Academy of Actuaries.