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Pricing Issues Resulting from Budget Setting and Stoploss in ACO Arrangements
ACO budgeting and pricing of stoploss coverage, including: 1) attribution of members; 2) claim carve outs; ... stoploss terms; 4) providers gaming the system and 5) credibility of data. ;; Health care reform; Health ...- Authors: Anthony Rubiano
- Date: May 2012
- Competency: External Forces & Industry Knowledge>Actuarial theory in business context; External Forces & Industry Knowledge>External forces and business performance; Technical Skills & Analytical Problem Solving>Problem analysis and definition; Technical Skills & Analytical Problem Solving>Process and technique refinement
- Publication Name: Health Watch
- Topics: Health & Disability>Health risks; Health & Disability>Payment models; Public Policy
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Bariatric Surgery Holds Promise for Patients and for Payors
Bariatric Surgery Holds Promise for Patients and for Payors An economic analysis of bariatric ... Payors An economic analysis of bariatric surgery and health care costs supports the case for health plans to ...- Authors: John Dawson, Pierre-Yves Cremieux, Arindam Ghosh
- Date: Jan 2011
- Competency: External Forces & Industry Knowledge>Actuarial methods in business operations; Results-Oriented Solutions>Actionable recommendations; Technical Skills & Analytical Problem Solving>Problem analysis and definition
- Publication Name: Health Watch
- Topics: Economics>Health economics; Experience Studies & Data; Health & Disability>Health risks; Modeling & Statistical Methods>Data mining
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Dental Coverage and the ACA
Coverage and the ACA This article discusses the challenges and unknowns relating to the regulatory inclusion ... inclusion of pediatric dental benefits within the essential benefits list of the Affordable Care Act (ACA) ...- Authors: Laurence R Weissbrot
- Date: May 2012
- Competency: External Forces & Industry Knowledge>Actuarial theory in business context; Technical Skills & Analytical Problem Solving>Problem analysis and definition
- Publication Name: Health Watch
- Topics: Health & Disability>Health insurance; Public Policy
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Health Watch, Issue 79, December 2015, Health Watch
insurance;Ethics;Health reserves;Health Research;Cause-of-death mortality;Disability;Presenteeism;Absenteeism;Smoking ... mortality;health care reform;actuarial standards of practice;Regression analysis;Predictive modeling;Modeling ...- Authors: Society of Actuaries
- Date: Dec 2015
- Competency: Communication>Written communication; External Forces & Industry Knowledge; Leadership>Influence; Professional Values>Ethical standards; Relationship Management>Team leadership; Results-Oriented Solutions>Actionable recommendations; Strategic Insight and Integration>Big picture view; Technical Skills & Analytical Problem Solving>Innovative solutions; Technical Skills & Analytical Problem Solving>Problem analysis and definition; Technical Skills & Analytical Problem Solving>Process and technique refinement
- Publication Name: Health Watch
- Topics: Experience Studies & Data>Disability; Health & Disability>Critical illness insurance; Health & Disability>Health care; Health & Disability>Health insurance; Health & Disability>Health risks; Modeling & Statistical Methods>Modeling efficiency; Modeling & Statistical Methods>Regression analysis; Technology & Applications>Computer science
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Reserving Challenges for Consumer-Directed Health Products
challenges for the actuaries responsi-ble for their development and upkeep. The introduction of consumer-directed ... exception. Actuaries responsible for the pricing and reserving of health reimbursement arrangements (HRAs) ...- Authors: Stephen J Kaczmarek
- Date: Oct 2004
- Competency: Technical Skills & Analytical Problem Solving>Problem analysis and definition
- Publication Name: Health Watch
- Topics: Health & Disability>Health insurance
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New Research Study Measurement of Health Care Quality and Efficiency: Resources for Health Care Professionals
Measurement of Health Care Quality and Efficiency: Resources for Health Care Professionals Review of a research ... co-sponsored by the SOA, which examined 83 organizations and over 150 programs that measure the quality and ...- Authors: Sara Teppema
- Date: Sep 2009
- Competency: External Forces & Industry Knowledge>External forces and business performance; Results-Oriented Solutions>Assess decision effectiveness; Technical Skills & Analytical Problem Solving>Problem analysis and definition
- Publication Name: Health Watch
- Topics: Health & Disability>Health care quality; Modeling & Statistical Methods>Data mining; Technology & Applications>Analytics and informatics; Technology & Applications>Business intelligence
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Medicare Advantage Star Ratings: Expectations for New Organizations
Medicare Advantage Star Ratings: Expectations for New Organizations This ... article makes organizations entering the MA market aware of the star rating climate, as well as short- ...- Authors: Kelly Backes, Julia Friedman, Dustin Grzeskowiak, Elizabeth Phillips, Patricia Zenner
- Date: Jun 2018
- Competency: External Forces & Industry Knowledge>External forces and business performance; External Forces & Industry Knowledge>Internal forces and business performance; Strategic Insight and Integration>Big picture view; Technical Skills & Analytical Problem Solving>Problem analysis and definition
- Publication Name: Health Watch
- Topics: Health & Disability>Health care; Health & Disability>Health insurance; Social Insurance>Medicare
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Rethinking Family Tiers
who was covered. The question we were asked: simply, what is the average cost of a child? We requested ... requested data on the average claims of this employer’s children, but by a stroke of luck we received ...- Authors: Kristi Bohn
- Date: Jan 2011
- Competency: External Forces & Industry Knowledge>Actuarial methods in business operations; Results-Oriented Solutions>Actionable recommendations; Technical Skills & Analytical Problem Solving>Problem analysis and definition
- Publication Name: Health Watch
- Topics: Modeling & Statistical Methods>Data mining; Technology & Applications>Analytics and informatics
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Why so Many People Have Untreated Mental Health Conditions
People Have Untreated Mental Health Conditions The article reviews high-deductible health plans and ... mental health providers as being the root of 3 devastating problems facing the US. Mental health care;Chronic ...- Authors: Dawn Motovidlak
- Date: Jun 2018
- Competency: Strategic Insight and Integration>Big picture view; Technical Skills & Analytical Problem Solving>Problem analysis and definition
- Publication Name: Health Watch
- Topics: Health & Disability>Chronic health management - Health & Disability; Health & Disability>Health care; Health & Disability>Health care quality; Health & Disability>Health insurance; Health & Disability>Health risks; Health & Disability>Payment models