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Navigate through Risk-Based Capital with Success
Introduce ... basic concepts of the Health Risk-Based Capital and show case a few strategies around Risk-Based Capital ...- Authors: Karena Weikel, Jinjun (Sophia) Yu
- Date: Dec 2021
- Competency: Strategic Insight and Integration
- Publication Name: Health Watch
- Topics: Actuarial Profession; Finance & Investments
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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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Changing With the Times: The Past and the Future of ACA Risk Adjustment
Changing With the Times: The Past and the Future of ACA Risk Adjustment ACA risk adjustment has now ... years. The original intent of risk adjustment was to help stabilize the market through measuring risk levels ...- Authors: Jason Karcher , Cameron Kevin Gleed, Jason James Petroske
- Date: Jun 2020
- Competency: External Forces & Industry Knowledge; Strategic Insight and Integration; Technical Skills & Analytical Problem Solving
- Publication Name: Health Watch
- Topics: Health & Disability; Health & Disability>Affordable Care Act (ACA)
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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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MACRA's Strategic Implications: What Providers and Health Plans Need to Know
Plans Need to Know MACRA not only impact providers, it will impact the entire healthcare market. MACRA ... primarily focused on providers, with the majority of the information addressing the impacts to clinicians ...- Authors: Julie Witt, James Dolstad
- Date: Jul 2019
- Competency: External Forces & Industry Knowledge; Strategic Insight and Integration
- Publication Name: Health Watch
- Topics: Economics; Economics>Health economics; Health & Disability
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How blockchain technology will disrupt the PBM-payer-pharmacy relationship
disrupt the PBM-payer-pharmacy relationship This article explores the disruptive applications of blockchain ... blockchain, an emerging technology, and its impact on the pharmacy benefit space, and pharmacy benefit managers ...- Authors: Brian Anderson, Michael DiPrima , Greg Callahan
- Date: Apr 2020
- Competency: External Forces & Industry Knowledge; Strategic Insight and Integration
- Publication Name: Health Watch
- Topics: Health & Disability; Technology & Applications; Technology & Applications>Blockchain & cryptocurrency
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Issue Brief: Changing Financial Risks for Medigap Insurance, Part 1
Insurance, Part 1 During the past few years, performance, cost, and risk trends for Medigap products ... undergone substantial changes. Some of these trends could ease cost pressures on Medigap insurers, while others ...- Authors: Kristi Bohn
- Date: Mar 2024
- Competency: External Forces & Industry Knowledge; Strategic Insight and Integration
- Publication Name: Health Watch
- Topics: Health & Disability; Health & Disability>Health insurance
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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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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