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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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Biosimilars, Part 4: The Financial Impact
Part 4: The Financial Impact Savings from biosimilars have accelerated significantly in the past few ... number of relatively recent biosimilar launches that can help to shape our expectations of the financial ...- Authors: Greg Warren, Tony Pistilli
- Date: Nov 2023
- Competency: External Forces & Industry Knowledge; Strategic Insight and Integration
- Publication Name: Health Watch
- Topics: Health & Disability; Health & Disability>Health care; Health & Disability>Health insurance; Public Policy; Public Policy; Public Policy
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Restoring the Indifference Ideal: If It’s Not Adjusting for “Risk,” It’s Not “Risk Adjustment”
Restoring the Indifference Ideal: If It’s Not Adjusting for “Risk,” It’s Not “Risk Adjustment” ACA risk adjustment ... intended to "bridge the gap" between allowed rates and actuarial rates. If risk adjustment methodology ...- Authors: Greg Fann
- Date: Jun 2022
- Competency: Strategic Insight and Integration
- Publication Name: Health Watch
- Topics: Experience Studies & Data; Health & Disability>Health care
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Managed Care 3.0 Technology
Technology Actuaries are currently familiar with the impact of new technologies used primarily by clinicians ... such as new drugs and devices. The common theme emerging from many of the articles points to a technological ...- Authors: Joan Barrett, Sudha Shenoy
- Date: Jan 2021
- Competency: Strategic Insight and Integration
- Publication Name: Health Watch
- Topics: Health & Disability>Health care; Technology & Applications
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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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Biosimilars, Part 3: Humira Biosimilar Launches
3: Humira Biosimilar Launches The big event of 2023 is the launch of multiple Humira biosimilars, which ... with the arrival of Amgen’s Amjevita on the market. The launch of Amjevita kicks off the process of changing ...- Authors: Tony Pistilli, Greg Warren
- Date: Nov 2023
- Competency: External Forces & Industry Knowledge; Strategic Insight and Integration
- Publication Name: Health Watch
- Topics: Health & Disability; Health & Disability>Health care; Health & Disability>Health insurance; Public Policy; Public Policy; Public Policy
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Medicaid and the ACA - Coverage of Medicaid home and community-based services under the 1915(i) state plan option
Medicaid and the ACA - Coverage of Medicaid home and community-based services under the 1915(i) state ... plan option Coverage of Medicaid home and community-based services under the 1915(i) state plan option: ...- Authors: Marlene Howard, Robert Damler
- Date: Jul 2015
- Competency: External Forces & Industry Knowledge; Professional Values; Strategic Insight and Integration
- Publication Name: In The Public Interest
- Topics: Health & Disability>Health care; Long-term Care>Public financing - Long-term Care; Social Insurance>Medicaid
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Paper 5: Evaluating Disease Management Savings Outcomes
This is one of a series of SOA-sponsored papers on the subject of Evaluating the Results of Care Management ... paper addresses the theory of measurement design and provides a practical evaluation of the most common designs ...- Authors: Ian G Duncan
- Date: Oct 2005
- Competency: Strategic Insight and Integration; Technical Skills & Analytical Problem Solving
- Topics: Health & Disability>Health care
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Behavioral Economics: Overview and Healthcare Applications
Healthcare Applications This article provides an overview of behavioral economic theory as it relates to health ... insurance plans and provides summaries of two sample applications of the theories: enrollment in health insurance ...- Authors: Randy P Herman, Tony Pistilli, Brian Plaskow, Jeffrey Chanin
- Date: Aug 2020
- Competency: External Forces & Industry Knowledge; Relationship Management; Results-Oriented Solutions; Strategic Insight and Integration; Technical Skills & Analytical Problem Solving
- Publication Name: Health Watch
- Topics: Economics; Economics>Behavioral economics; Economics>Health economics; Health & Disability; Health & Disability>Health care
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Accountable Care Organizations: An Untapped Opportunity
provider risk under various ACO models, limitations of the Medicare model for motivating change in the health ... strategic priorities, attribution of members, meaurement, and the roles actuaries can play. Accountable ...- Authors: Jim Toole, Sara Teppema
- Date: Sep 2010
- Competency: External Forces & Industry Knowledge>External forces and business performance; Leadership>Thought leadership; Professional Values>Public interest representation; Strategic Insight and Integration
- Publication Name: Health Watch
- Topics: Enterprise Risk Management>Risk measurement - ERM; Enterprise Risk Management>Strategic risks; Health & Disability>Health care; Public Policy