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Better Care Through Understanding the Customer Not Just the Patient
actuaries in health care, we spend most of our time focused on reviewing claims, enrollment and clinical ... small fraction of their time in these facilities. This article explores what types of data are available ...- Authors: James Dolstad, Craig Cartossa, Justin Hartmann
- Date: Dec 2021
- Competency: Results-Oriented Solutions; Strategic Insight and Integration; Technical Skills & Analytical Problem Solving
- Publication Name: Health Watch
- Topics: Health & Disability; Health & Disability>Health care; Health & Disability>Health care quality; Health & Disability>Health insurance; Health & Disability>Health risks; Health & Disability>Payment models; Predictive Analytics; Health & Disability>Provider networks; Health & Disability>Provider risk; Predictive Analytics>Modeling techniques
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Give Me Some Credibility: Addressing the Challenge of Volatility in Value-Based Contracts—Part 2
Addressing the Challenge of Volatility in Value-Based Contracts—Part 2 Discover the key components of value-based ... their impact on provider credibility. Learn about benchmarks, measurement period results, and the unique ...- Authors: Maria Knox, James Pisko, Keith Passwater
- Date: May 2023
- Competency: External Forces & Industry Knowledge; Results-Oriented Solutions; Technical Skills & Analytical Problem Solving
- Publication Name: Health Watch
- Topics: Health & Disability; Health & Disability>Health care; Health & Disability>Health care quality; Health & Disability>Health insurance; Predictive Analytics; Health & Disability>Provider networks; Health & Disability>Provider risk; Predictive Analytics>Modeling techniques
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MACRA/QPP Provider Revenue Model
Model The MACRA/QPP Provider Revenue Model is designed to provide an estimate of the revenue impact of the ... the QPP (MIPS, AAPM) on a provider group or ACO, based on the required inputs and scenarios. Healthcare ...- Authors: Julie Witt
- Date: Sep 2019
- Competency: External Forces & Industry Knowledge
- Topics: Health & Disability>Health care quality; Health & Disability>Affordable Care Act (ACA); Health & Disability>Provider risk
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Our Value-Based Cup Runneth Over
Our Value-Based Cup Runneth Over Discussion of how to mature value-based contracts between health insurers ... parameter consistency, revenue predictability and risk assessment. Intended audience are health plan and ...- Authors: Daniel Reck (Dan), Lisa Swan, Sam Johnmeyer
- Date: Aug 2022
- Competency: Communication; External Forces & Industry Knowledge; Strategic Insight and Integration
- Publication Name: Health Watch
- Topics: Enterprise Risk Management>Risk appetite; Enterprise Risk Management>Risk measurement - ERM; Health & Disability>Chronic health management - Health & Disability; Health & Disability>Health care quality; Health & Disability>Health insurance; Health & Disability>Payment models; Health & Disability>Provider risk
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Understanding the Medical Stop-Loss Market
Understanding the Medical Stop-Loss Market This article details the medical stop-loss coverages purchased ... providers taking delegated financial risk in payor agreements. Along the way we will identify strategies purchasers ...- Authors: Keith Passwater, Peter Robinson, David Nelson
- Date: Jun 2022
- Competency: External Forces & Industry Knowledge
- Publication Name: Health Watch
- Topics: Reinsurance; Health & Disability>Provider risk
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Yi-Ling Lin: SOA Predictive Analytics Program Prepares You for Health Care’s Future
FCA, started the SOA’s Predictive Analytics Certificate Program to keep pace with the impact big data and ... and predictive modeling is having on the health care industry predictive analytics certificate program ...- Authors: Society of Actuaries
- Date: Nov 2019
- Topics: Health & Disability; Health & Disability>Chronic health management - Health & Disability; Health & Disability>Health care; Health & Disability>Health care quality; Health & Disability>Health information technology; Health & Disability>Health insurance; Health & Disability>Health risks; Health & Disability>Payment models; Predictive Analytics; Health & Disability>Affordable Care Act (ACA); Health & Disability>Association Health Plans; Health & Disability>Claims - Health & Disability; Health & Disability>Provider networks; Health & Disability>Provider risk; Predictive Analytics>Modeling techniques; Predictive Analytics>Programming languages & tools; Health & Disability>Electronic medical record
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Provider Risk-Sharing and Random Noise
Provider Risk-Sharing and Random Noise Discussion and Opinion on how randomness affects measurement of provider ... provider contracting risk-sharing agreements 7/3/2019 12:00:00 AM ...- Authors: Thomas Messer
- Date: Jul 2019
- Competency: External Forces & Industry Knowledge; Strategic Insight and Integration; Technical Skills & Analytical Problem Solving
- Publication Name: Health Watch
- Topics: Health & Disability>Health care; Health & Disability>Health care quality; Health & Disability>Payment models; Health & Disability>Provider networks; Health & Disability>Provider risk
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Money Matters: Making Medicaid Payment More Effective Through Population-Based Payment
implementing value-based payment (VBP) models for the last decade and are increasingly exploring advanced ... advancing Medicaid priorities, but are still in the early stages of development, and model design and implementation ...- Authors: Anne Smithey, Kelsey Brykman
- Date: May 2023
- Competency: External Forces & Industry Knowledge
- Publication Name: In The Public Interest
- Topics: Health & Disability; Health & Disability>Health care quality; Health & Disability>Payment models; Health & Disability>Public financing - Health & Disability; Social Insurance; Social Insurance>Medicaid; Health & Disability>Provider risk
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AI and EMRs: Pioneering the New Frontier in Healthcare Actuarial Practice
EMRs: Pioneering the New Frontier in Healthcare Actuarial Practice In the evolving realm of healthcare actuarial ... contracts are reshaping the landscape. This article explores the pivotal role of AI-enhanced Electronic ...- Authors: Netanel Lederer
- Date: May 2024
- Competency: External Forces & Industry Knowledge; Strategic Insight and Integration; Technical Skills & Analytical Problem Solving
- Publication Name: Innovators & Entrepreneurs
- Topics: Health & Disability; Health & Disability>Health care; Health & Disability>Health information technology; Health & Disability>Provider risk; Health & Disability>Electronic medical record
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Ehren Nagel: SOA Predictive Analytics Certificate Has Positively Impacted My Work
But when he began working on a stochastic mortality project, he realized the SOA’s Predictive Analytics ... Analytics Certificate Program could help him make sense of the research and direct it toward actionable policy ...- Authors: Society of Actuaries
- Date: Nov 2019
- Topics: Health & Disability; Health & Disability>Chronic health management - Health & Disability; Health & Disability>Health care; Health & Disability>Health care quality; Health & Disability>Health information technology; Health & Disability>Health insurance; Health & Disability>Health risks; Health & Disability>Payment models; Predictive Analytics; Health & Disability>Affordable Care Act (ACA); Health & Disability>Association Health Plans; Health & Disability>Claims - Health & Disability; Health & Disability>Provider networks; Health & Disability>Provider risk; Predictive Analytics>Modeling techniques; Predictive Analytics>Programming languages & tools; Health & Disability>Electronic medical record