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Improving Outcomes Through Incentives: Using a Global Budget with Risk Sharing to Drive Cost Savings and Improved Quality
we exceed the tar- get. For example, as shown in Table 1, the hospital provider partner can exercise a ... program produced by the adverse impacts of an individual catastrophic claim on the incentive pool. In ...- Authors: Edward Cymerys
- Date: May 2013
- Competency: Relationship Management>Relationships and trust; Results-Oriented Solutions>Actionable recommendations; Strategic Insight and Integration>Management partnership; Technical Skills & Analytical Problem Solving>Innovative solutions
- Publication Name: Health Watch
- Topics: Health & Disability>Health care; Health & Disability>Health insurance; Health & Disability>Payment models
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The Medicare Advantage 5-Star Rating Program and Its Implications for Actuaries
payment percentages by star rat- ing are shown in the table in Figure 1. The percentage of the savings a plan ... rebate percentages by star rating are shown in the table in Figure 2. Special rules apply to low-enrollment ...- Authors: Adrian L Clark, Gabriela Dieguez, Bradley James Piper
- Date: May 2012
- Competency: External Forces & Industry Knowledge>External forces and business performance; Results-Oriented Solutions>Actionable recommendations; Strategic Insight and Integration>Strategy development; Technical Skills & Analytical Problem Solving>Problem analysis and definition
- Publication Name: Health Watch
- Topics: Health & Disability>Health insurance; Health & Disability>Payment models; Public Policy
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Health Watch Issue 73, October 2013
program is a temporary feature that will apply to individual and small group qualified health plans (QHPs) ... grandfathered plans, self-funded plans, and non-QHP individual and small group plans will not participate in ...- Authors: Karen Perry, Society of Actuaries
- Date: Oct 2013
- Competency: Results-Oriented Solutions>Actionable recommendations
- Publication Name: Health Watch
- Topics: Health & Disability>Health care; Health & Disability>Health care quality; Health & Disability>Health insurance; Health & Disability>Payment models
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Health Watch, Issue 72, May 2013
and opinions expressed herein are those of the individual authors and are not necessarily those of the ... we exceed the tar- get. For example, as shown in Table 1, the hospital provider partner can exercise a ...- Authors: Society of Actuaries
- Date: May 2013
- Competency: Results-Oriented Solutions>Actionable recommendations
- Publication Name: Health Watch
- Topics: Health & Disability>Health care; Health & Disability>Health care quality; Health & Disability>Health insurance; Health & Disability>Payment models
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An Actuarial Model to Improve Health and Reduce Costs
health care costs and an ever-increasing share of individual, corporate and government budgets.1 While everyone ... Health Care Data, 2009–2010 Combined Year Tables—Table 1. Annual Number and Percent Distribution of Ambula- ...- Authors: Ken Beckman
- Date: Oct 2017
- Competency: Leadership>Thought leadership; Results-Oriented Solutions>Actionable recommendations; Technical Skills & Analytical Problem Solving>Innovative solutions
- 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>Payment models; Public Policy
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Palliative Care
Palliative Care This article from major US payers describes palliative care as a scaleable ... programs can be broadly cate- gorized as shown in Table 1. Table 1 Categories of Palliative Care Programs Program ...- Authors: Randall Krakauer, Bruce Smith, Diane Meier, Torrie Fields
- Date: Nov 2016
- Competency: Leadership>Change management; Leadership>Influence; Leadership>Mentoring; Leadership>Professional network leverage; Leadership>Thought leadership; Results-Oriented Solutions>Actionable recommendations; Results-Oriented Solutions>Assess decision effectiveness; Strategic Insight and Integration>Big picture view; Strategic Insight and Integration>Effective decision-making
- Publication Name: Health Watch
- Topics: Economics>Health economics; Enterprise Risk Management>Systematic risk; Experience Studies & Data>Morbidity; Experience Studies & Data>Mortality; Health & Disability>Chronic health management - Health & Disability; Health & Disability>Health care quality; Health & Disability>Payment models
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Medicare Advantage risk scores – Are you competitive?
average number of HCCs between employer group and individual members after accounting for age/gender ... Competitive? and dual status, we included both individual and employer group members in the analysis used ...- Authors: Corey Berger
- Date: Oct 2018
- Competency: Results-Oriented Solutions>Actionable recommendations; Strategic Insight and Integration>Big picture view; Technical Skills & Analytical Problem Solving>Innovative solutions
- Publication Name: Health Watch
- Topics: Health & Disability>Health insurance; Health & Disability>Health risks; Health & Disability>Payment models; Social Insurance>Medicare
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Provider Payment Reform: An Accountable Care Approach to Alignment of Health Care Goals and Incentives
Provider Payment Reform: An Accountable Care Approach to Alignment of Health Care Goals ... for the entire organization, not that of the individual physician. This will encourage better coor- dination ...- Authors: Mark Florian
- Date: Sep 2010
- Competency: Leadership>Thought leadership; Professional Values>Public interest representation; Results-Oriented Solutions>Actionable recommendations; Strategic Insight and Integration>Strategy development
- Publication Name: Health Watch
- Topics: Economics>Health economics; Health & Disability>Health care quality; Health & Disability>Payment models; Public Policy; Reinsurance>Stop-loss insurance