Description: This article reviews underwriting and why it has remained unchanged for 50 years. The unhealthy lifestyles of Americans are examined. From Health Watch Newsletter, May 2006, Issue No. 52.

Description: Using Healthcare Claims Data to Create Actuarial Models.

Description: This article summarizes some of the operational considerations necessary to optimize the usefulness and impact of a predictive model, such as cross-functional support and involvement in model build, adequate training and reporting, and strategic model build.

Description: Blockchain technology has the potential to significantly improve the quality of life and overall health of the members of a health system, while also adding to administrative efficiencies. For the first time, we will have access to members’ entire diagnoses and prescription history, consumer behavioral attributes, and other socio-economic determinants which that are valuable inputs to designing appropriate benefits and proper care management plans. Through the blockchain, we will be able to access data not just of the existing members of the health system but also of potential enrollees and new entrants. The data can be accessed by querying the blockchain through a permissioned granted by the member. This information can be very useful in performing feasibility studies for evaluating entry into newer markets and/or newer products, developing customized care plans, and designing efficient value-based contracts. By executing smart contracts on the blockchain, we will be able to achieve administrative efficiencies like never before. The applications of blockchain technology are numerous and ground-breaking. Organizations that do not pay heed to the benefits that blockchain can bring may find themselves left behind as the rest of the industry marches forward in its quest for efficiency and member satisfaction.

Description: Using the Internet as a Pricing Tool clinical background information, defining the change in coverage, collecting data, data quality and data limitations. Issue No. 39.

Description: This article discusses the positive aspects of E-prescribing, a transaction in which a physician transmits a prescription directly to a pharmacy through an electronic device. Issue No. 60

Description: A discussion of permissible use and collection of genetic information for Health Risk Assessments and wellness programs under the Genetic Information Nondiscrimination Act of 2008.

Description: Recent health care reform activity has highlighted the importance of Clinical Integration in improving the quality, safety, efficiency and reimbursement infrastructure of the health care system. This article discusses relevance and implication of regulatory measures, implementation and data issues, and provides an end-to-end example.

Description: A closer look at family tier factor rating assumptions, and how well they reflect actual claim cost data.

Description: New research shows that we often make sub-optimal choices, when selecting a health insurance plan, that lead to unnecessary out-of-pocket expenditu