Description: Discover the key components of value-based care (VBC) contracts and their impact on provider credibility. Learn about benchmarks, measurement period results, and the unique challenges providers face in managing insurance risk. Gain insights into reducing costs and aligning financial incentives in the US healthcare market.

Description: This article details the medical stop-loss coverages purchased by HMOs, small insurers and providers taking delegated financial risk in payor agreements. Along the way we will identify strategies purchasers often use to save money on medical stop-loss.

Description: Considerations in the applications of Predictive Modeling for health care management. Issue No. 47.

Description: Full version of Health Section News, April 2004, Issue No. 47.

Description: Summary of lessons learned from Health Insurer Chief Actuaries' prior economic recession experience and suggestions for those leading Health insurers through future recessions

Description: Any prudent organization that is obligated to cover health claims will consider the risk that those medical claims vastly exceed expectations. This is true for an employer self-funding employee health benefits, a health system contracted with two-way risk (e.g., Accountable Care Organizations ACOs), and a small or mid-sized health insurance company. Without protection, these risk bearers can incur ruinous losses. Interestingly, the forms of insurance sold to cover such large medical claims, although quite similar, sometimes go by different names depending upon the buyer. • Employer Stop-loss (ESL): self-funded employers who want protection against large unanticipated claims • Provider Excess (PXS): at-risk health systems who have taken delegated risk from a public or private payer and desire protection against large unanticipated claims • Medical Excess/HMO Reinsurance (HMO Re): health insurers (including HMOs) who desire protection against large unanticipated claims The concepts we discuss in this article apply to all three categories of large claim risk.

Description: Vast sums of private equity are flowing into start-ups intent on lowering healthcare trend. This presents a huge challenge for insurance company actuaries to stay current on such start-ups and the innovations they're advancing. Further, it can be overwhelming to evaluate the many vendors eager to sell their services to the company. This session will provide an overview of the start-up and private equity process, review some of the emerging innovators, and discuss approaches to evaluate their Return on Investment (ROI) as efficiently as possible.

Description: All you wanted to know about InsurTech but were too afraid to ask! This one-day event will feature four webcasts that will unlock and enhance the world of InsurTech. By attending this webs series, you will find answers on what InsurTech is about and what it’s trying to solve. Dive deeper into the successes of InsurTech and find out how to join this established organization. Session 1 – Introduction to InsurTech Set the stage for the day, defining the main types of InsurTech companies and where these companies fit in the insurance value chain. Come discover where actuaries could play a role and the importance of the profession within this space. Technology driven innovation is multifaceted and could take place within an established carrier or a start-up.

Description: All you wanted to know about InsurTech but were too afraid to ask! This one-day event will feature four webcasts that will unlock and enhance the world of InsurTech. By attending this webs series, you will find answers on what InsurTech is about and what it’s trying to solve. Dive deeper into the successes of InsurTech and find out how to join this established organization. Session 1 – Introduction to InsurTech Set the stage for the day, defining the main types of InsurTech companies and where these companies fit in the insurance value chain. Come discover where actuaries could play a role and the importance of the profession within this space. Technology driven innovation is multifaceted and could take place within an established carrier or a start-up.

Description: Session 2– Going Deeper through examples InsurTech (1) identifies a pain point to the industry, (2) brings a technology solution to address the shortcoming with a (3) business model that makes sense for all. Expect an illustration of this three-point structure through a handful of start-ups from various backgrounds (health, life, general operation) dealing with various aspects of the insurance value chain (acquisition, risk management, back-office…).