Description: A proposal to address provider payment issues by gradually moving to accountable care organizations. Capitations would be risk-adjusted, non-capitated costs would be covered by hospitalization fund and stoploss, incentives for quality & effective preventive care would be tied to the amount remaining in the fund, and government involvement would be through incentives rather than mandate.

Description: Read the March 2017 issue of Health Watch, published by the Health Section. Practical information for actuaries, articles impact sections, section activities.

Description: Article explores why many integrated delivery systems are struggling and what actions they need to take to succeed.

Description: This article includes a summary of 2012 Health section activities as well as upcoming events, including the Health '12 Meeting, two HARI research projects (ACOs and risk adjustment), the value of health section membership, and our Canadian Outreach.

Description: A rethinking of current provider reimbursement, focusing on incentives instead of simply cutting fees. The recommended 2-pronged approach would feature integrated provider organizations as well as evidence-based decision making organized around episodes of care.

Description: Read the February 2018 issue of Health Watch, published by the Health Section. Practical information for actuaries, articles impact sections, section activities.

Description: Risk adjustment is used to adjust the revenue stream to health insurers that sell ACA eligible plans and Medicare Advantage plans. This article compares and contrasts these risk adjustment programs.

Description: The healthcare industry is in the middle of extraordinary times. This article outlines the many forces driving this transformation, as well as various obstacles. This has both personal and business implications to health actuaries.

Description: Highlights of health related articles from the North American Actuarial Journal. A paper on health care reform and efficiency is published in a recent issue of the NAAJ.

Description: This article will consider several issues arising from ACO budgeting and pricing of stoploss coverage, including: 1) attribution of members; 2) claim carve outs; 3) ambiguous stoploss terms; 4) providers gaming the system and 5) credibility of data.