Description: Epilogue to ACA@5 publication

Description: The Health Plan Employee Data and Information Set 'HEDIS' is a set of standardized performance measures initially designed to enable purchasers of health care to evaluate and compare a managed care plan’s administrative performance. The National Committee for Quality Assurance, known as the NCQA, developed HEDIS in 1991. Since its introduction, HEDIS has become a widely used tool for measuring a broad array of health plan functions. This study evaluates the reliability and validity of HEDIS measures. It also reviews the usefulness of HEDIS as an indicator of health care quality.

Description: Analysis of possible mathematical relationships between hospital quality and hospital billed or allowed charges or other measures, using quality data as defined by the U.S. Department of Health and Human Services along with the Hospital Quality Alliance for their Hospital Quality Initiative.

Description: Discussion of how to mature value-based contracts between health insurers and provider organizations to improve population health and financial sustainability. Centers around contract parameter consistency, revenue predictability and risk assessment. Intended audience are health plan and ACO actuaries and leaders. Authors are writing from the provider perspective in value-based contracts.

Description: Discover the key components of value-based care (VBC) contracts and their impact on provider credibility. Learn about benchmarks, measurement period results, and the unique challenges providers face in managing insurance risk. Gain insights into reducing costs and aligning financial incentives in the US healthcare market.

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: Research project that reviewed and inventoried the range of quality and efficiency measures that demonstrate the performance of hospitals and physicians. Besides outlining key areas of consideration for quality and efficiency measurement, this report also describes future opportunities for actuaries and other health professionals interested in this evolving area. The inventory part of this report is in a separate document.

Description: By rationing heath care resources, managed-care organizations have raised ethical and legal issues not commonly found under previous health-care-financing structures. Panelists, including a member of the Board and the Executive Committee of the American Medical Association [AMA], and the audience debate this issue. From the 1997 Record of Society of Actuaries, Vol. 23, No. 3.

Description: Panelists discuss employers' perspective of defining strategies to identify best-in-market opportunities. From the Record of the Society of Actuaries, Vol. 24, No. 1.

Description: Medicaid and the ACA