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A Comparison Between the ACA Exchange and Medicare Risk Adjustment Programs
A Comparison Between the ACA Exchange and Medicare Risk Adjustment Programs Risk adjustment is used to adjust the revenue stream to health insurers that sell ACA eligible plans and Medicare ...- Authors: Kurt Wrobel
- Date: Jan 2015
- Competency: External Forces & Industry Knowledge
- Publication Name: Health Watch
- Topics: Health & Disability>Health insurance; Health & Disability>Health risks; Health & Disability>Payment models; Social Insurance>Medicare
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Modeling the Unwinding—Where Are We Now?
Modeling the Unwinding—Where Are We Now? Article reviews the data a year into the unwinding of continuous coverage provisions in Medicaid, the impact on enrollment counts, how capitation rates ...- Authors: Colby Schaeffer
- Date: May 2024
- Competency: External Forces & Industry Knowledge; Results-Oriented Solutions; Technical Skills & Analytical Problem Solving
- Publication Name: Health Watch
- Topics: Health & Disability; Health & Disability>Health risks; Health & Disability>Public financing - Health & Disability
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Strategies for Leveraging the ACA Risk Adjuster
Strategies for Leveraging the ACA Risk Adjuster This article begins with a comparison of the commercial risk adjuster to the exisiting Medicare model, and goes on to discuss why the existing ...- Authors: Jason Siegel
- Date: Oct 2013
- Competency: Technical Skills & Analytical Problem Solving>Incorporate risk management
- Publication Name: Health Watch
- Topics: Health & Disability>Health care; Health & Disability>Health insurance; Health & Disability>Health risks
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Pricing Issues Resulting from Budget Setting and Stoploss in ACO Arrangements
Pricing Issues Resulting from Budget Setting and Stoploss in ACO Arrangements This article will consider several issues arising from ACO budgeting and pricing of stoploss coverage, including: 1) ...- 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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Bariatric Surgery Holds Promise for Patients and for Payors
Bariatric Surgery Holds Promise for Patients and for Payors An economic analysis of bariatric surgery and health care costs supports the case for health plans to cover these procedures. Health ...- Authors: John Dawson, Pierre-Yves Cremieux, Arindam Ghosh
- Date: Jan 2011
- Competency: External Forces & Industry Knowledge>Actuarial methods in business operations; Results-Oriented Solutions>Actionable recommendations; Technical Skills & Analytical Problem Solving>Problem analysis and definition
- Publication Name: Health Watch
- Topics: Economics>Health economics; Experience Studies & Data; Health & Disability>Health risks; Modeling & Statistical Methods>Data mining
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The State of Predictive Analytics in U.S. Health care
The State of Predictive Analytics in U.S. Health care Health care predictive analytics varies between payers and providers as well as being a powerful tool in business decision modeling. Data ...- Authors: Marilyn Medved McGaffin
- Date: Nov 2016
- Competency: External Forces & Industry Knowledge>Actuarial methods in business operations; Technical Skills & Analytical Problem Solving>Problem analysis and definition
- Publication Name: Health Watch
- Topics: Health & Disability>Health risks; Predictive Analytics
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Understanding Health in the Big Picture
Understanding Health in the Big Picture Social determinants of health (SDoH) have been a topic of growing interest in recent years, yet consensus about what the phrase represents and how ...- Authors: Jill Van Den Bos, Stoddard Davenport
- Date: Aug 2021
- Competency: External Forces & Industry Knowledge
- Publication Name: Health Watch
- Topics: Health & Disability>Health care; Health & Disability>Health care quality; Health & Disability>Health risks
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Additional Actuarial Perspectives on Prescription Drug Financing
Additional Actuarial Perspectives on Prescription Drug Financing Introduction to additional actuarial research into development of and regulatory impact, economic impact and consumer impact of ...- Authors: Gregory L Warren
- Date: Apr 2021
- Competency: External Forces & Industry Knowledge
- Publication Name: Health Watch
- Topics: Health & Disability>Health care quality; Health & Disability>Health insurance; Health & Disability>Health risks; Health & Disability>Public financing - Health & Disability
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An Interview: Dr. Uwe Reinhardt
An Interview: Dr. Uwe Reinhardt In this interview Dr. Reinhardt shares his thoughts on the role he believes actuaries should take in the health care system reforms. Assumptions;Episode-based ...- Authors: Mary Kindel Van der Heijde, Douglas Norris
- Date: Sep 2009
- Competency: External Forces & Industry Knowledge>Actuarial methods in business operations; Leadership>Thought leadership; Strategic Insight and Integration>Effective decision-making; Technical Skills & Analytical Problem Solving>Problem analysis and definition
- Publication Name: Health Watch
- Topics: Actuarial Profession>Traditional careers; Enterprise Risk Management; Health & Disability>Health risks; Health & Disability>Payment models
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Health Risk Assessments in a Protected Environment
Health Risk Assessments in a Protected Environment A discussion of permissible use and collection of genetic information for Health Risk Assessments and wellness programs under the Genetic ...- Authors: John C Cameron
- Date: May 2010
- Competency: External Forces & Industry Knowledge>Actuarial methods in business operations; Professional Values>Ethical standards
- Publication Name: Health Watch
- Topics: Health & Disability>Health risks; Public Policy; Technology & Applications>Analytics and informatics