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Consumerism and Consumer Choice - Implications for Health Plans
Consumerism and Consumer Choice - Implications for Health Plans The session covers strategies and products health plans are developing to address consumer choice. From the Record of the Society ...- Authors: David Ogden, William M Sneden, David M Tuomala, Ryan Levin
- Date: May 2001
- Competency: Strategic Insight and Integration
- Publication Name: Record of the Society of Actuaries
- Topics: Health & Disability>Health care
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Behavioral Economics: Overview and Healthcare Applications
Behavioral Economics: Overview and Healthcare Applications This article provides an overview of behavioral economic theory as it relates to health and welfare insurance plans and provides ...- 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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Biosimilars, Part 4: The Financial Impact
Biosimilars, Part 4: The Financial Impact Savings from biosimilars have accelerated significantly in the past few years. There has been a number of relatively recent biosimilar launches that can ...- 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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Provider Risk-Sharing and Random Noise
Provider Risk-Sharing and Random Noise Discussion and Opinion on how randomness affects measurement of 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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Nuts and Bolts of Managed-Care Provider Networks
Nuts and Bolts of Managed-Care Provider Networks This session is about managed-care provider networks: organizing networks, information needs, monitoring utilization and risk/reward ...- Authors: Nancy F Nelson, Application Administrator, Richard W Kaplan
- Date: Apr 1993
- Competency: Strategic Insight and Integration
- Publication Name: Record of the Society of Actuaries
- Topics: Health & Disability>Health care
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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 ...- 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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Better Care Through Understanding the Customer Not Just the Patient
As actuaries in health care, we spend most of our time focused on reviewing claims, enrollment and clinical data. That information is captured while patients are in health care facilities. Yet ...- 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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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 is intended to "bridge the gap" between allowed rates and actuarial rates.- 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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Accountable Care Organizations: An Untapped Opportunity
Accountable Care Organizations: An Untapped Opportunity Since health care reform has made accountable care organizations a hot topic, an SOA workgroup is addressing relevant questions, including ...- 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
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New Contract Medicare Star Ratings: Why The Sudden Cliff?
New Contract Medicare Star Ratings: Why The Sudden Cliff? On average, contracts receiving their first star rating receive 3.20 stars, compared to existing or established contracts receiving 3.90 ...- Authors: Suzanna-Grace Sayre, Danielle Beierle
- Date: Jan 2020
- Competency: External Forces & Industry Knowledge; Results-Oriented Solutions; Strategic Insight and Integration
- Publication Name: Health Watch
- Topics: Health & Disability; Health & Disability>Health care; Health & Disability>Health care quality; Health & Disability>Health insurance