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Pricing Issues Resulting from Budget Setting and Stoploss in ACO Arrangements
Pricing Issues Resulting ... In n e R S o f T h e h e A lT h W A T C h A R T IC l e C o n T e S T 30 | ... decrease in quality. The insurer and ACO provider(s) should develop clear definitions of quality and ...- Authors: Anthony Rubiano
- Date: May 2012
- Competency: External Forces & Industry Knowledge>Actuarial theory in business context; External Forces & Industry Knowledge>External forces and business performance; Technical Skills & Analytical Problem Solving>Problem analysis and definition; Technical Skills & Analytical Problem Solving>Process and technique refinement
- Publication Name: Health Watch
- Topics: Health & Disability>Health risks; Health & Disability>Payment models; Public Policy
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Accountable Care Organizations: An Untapped Opportunity
third-party, objective analysis when they are at the table bargain- 8 | september 2010 | Health Watch area ... health care costs if actuaries had been at the table with providers earlier in the process. ACO leadership ...- 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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ERM Opportunities for Health Practitioners
ERM Opportunities for Health Practitioners Summary of recent SOA-sponsored research on Enterprise ... appropriate for them to take a seat at the ERM table and be considered to head this team. As with any ...- Authors: Max Rudolph
- Date: May 2010
- Competency: Communication; External Forces & Industry Knowledge>External forces and business performance; Leadership>Change management; Technical Skills & Analytical Problem Solving>Problem analysis and definition
- Publication Name: Health Watch
- Topics: Actuarial Profession>Alternative careers; Actuarial Profession>Best practices; Enterprise Risk Management; Enterprise Risk Management>Compliance
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The Medicare Advantage 5-Star Rating Program and Its Implications for Actuaries
payment percentages by star rat- ing are shown in the table in Figure 1. The percentage of the savings a plan ... rebate percentages by star rating are shown in the table in Figure 2. Special rules apply to low-enrollment ...- 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