Using Medical Loss Ratio Data to Determine Insurers’ Administrative Costs and Investments in Quality Improvement


In an attempt to reduce the amount private health insurance plans spend on administration and other items not directly related to patient care, the Affordable Care Act requires commercial carriers to maintain a minimum medical loss ratio (MLR). In 2012, health plans with MLRs below the minimum will be required to rebate their members the difference. To enforce the new rule, carriers must report on standardized forms detailed information about their administrative expenses, their profits, and their efforts to improve quality of care. The project team will analyze this newly collected information, map out compliance with the MLR requirement in each state, and assess the stability and structure of the health insurance marketplace in each state. The findings will yield important insights for regulators and policymakers striving to increase the efficiency of insurance markets.

Grant Details

Grantee Organization:
Wake Forest University Health Sciences
Principal Investigator:
Mark A. Hall, J.D.
Award Amount:
Approval Date:
November 15, 2011

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