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Building Actuarial Cost Models From Health Care Claims Data
across the country generates billions of claim records annually. Claim records originate as a form of invoice ... Providers submit the claims to the liable payer (typically a health plan, government agency or the patient) ...- Authors: William Bednar
- Date: Jun 2017
- Competency: External Forces & Industry Knowledge>Actuarial methods in business operations; Results-Oriented Solutions>Actionable recommendations; Strategic Insight and Integration>Influence decisions; Technical Skills & Analytical Problem Solving>Innovative solutions; Technical Skills & Analytical Problem Solving>Problem analysis and definition
- Publication Name: Health Watch
- Topics: Health & Disability>Health insurance; Technology & Applications>Analytics and informatics; Technology & Applications>Business intelligence
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Improving Outcomes Through Incentives: Using a Global Budget with Risk Sharing to Drive Cost Savings and Improved Quality
Improving Outcomes Through Incentives: Using a Global Budget with Risk Sharing to Drive ... Quality This article describes the results of three years of work by Blue Shield of California to collaborate ...- 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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Medicare Advantage risk scores – Are you competitive?
Medicare Advantage risk scores – Are you competitive? What you need to know about ... need to know about risk scores to be competitive in the Medicare Advantage market. Medicare;Risk adjustment;Health ...- 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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The Medicare Advantage 5-Star Rating Program and Its Implications for Actuaries
The Medicare Advantage 5-Star Rating Program and Its Implications for Actuaries Explanation of Medicare ... important features of the program from an actuarial perspective, how the components of the STAR rating are ...- 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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Navigating Cost-Sharing Reduction Subsidy Defunding
and Michael Cohen As part of the Affordable Care Act (ACA), carriers in the individual market are required ... silver plan, with the requirement that the carrier must charge the same premium as the standard plan. These ...- Authors: Michael Cohen, Peter van Laarhoven
- Date: Mar 2019
- Competency: Professional Values>Practice expertise; Results-Oriented Solutions>Actionable recommendations; Strategic Insight and Integration>Big picture view
- Publication Name: Health Watch
- Topics: Health & Disability>Health insurance; Public Policy
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Recommendations for a Successful ACA Rate Filing
Recommendations for a Successful ACA Rate Filing Summary of common mistakes made by actuaries developing ACA ...- Authors: Joseph Slater
- Date: Nov 2016
- Competency: Communication>Difficult message delivery; Communication>Oral communication; Communication>Persuasive communication; Communication>Written communication; Results-Oriented Solutions>Actionable recommendations; Technical Skills & Analytical Problem Solving>Process and technique refinement
- Publication Name: Health Watch
- Topics: Actuarial Profession>Best practices; Health & Disability>Health insurance; Public Policy
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Self-Insurance Strategic Initiative Report
Report This monograph explains the ways actuaries are or could be involved in the self-insured employer health ... health plan marketplace today and in the future. Health insurance 6442482694 6/11/2018 12:00:00 AM ...- Authors: Society of Actuaries, John Mange, Kristi Bohn, Hobson Carroll, Michael A Kemp, Mehboob Khoja, David E Olsho, Shaun Peterson, Nicholas Sarneso, Brent Seiler, Joseph Slater, Dustin Tindall, David Wilson, Gregory J Sullivan
- Date: Jun 2018
- Competency: External Forces & Industry Knowledge>Actuarial theory in business context; Results-Oriented Solutions>Actionable recommendations
- Topics: Health & Disability>Health insurance