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Improving Medicare Advantage Star Ratings: An Analytical Framework
Improving Medicare Advantage Star Ratings: An Analytical Framework This paper outlines a framework for assisting a STARS manager in implementing a quantitative approach to prioritize stars ...- Authors: Puneet Budhiraja, Rajesh Munjuluri
- Date: Oct 2018
- Publication Name: Health Watch
- Topics: Health & Disability>Health care; Health & Disability>Payment models; Health & Disability>Public financing - Health & Disability; Technology & Applications>Analytics and informatics
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Health Care 2.0—Massive Implications of System Transformation
Health Care 2.0—Massive Implications of System Transformation The healthcare industry is in the middle of extraordinary times. This article outlines the many forces driving this transformation, ...- Authors: Greger J Vigen
- Date: May 2013
- Publication Name: Health Watch
- Topics: Economics>Health economics; Health & Disability>Payment models; Public Policy
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Abstracts of Health Articles from the North American Actuarial Journal
Abstracts of Health Articles from the North American Actuarial Journal Highlights of health related articles from the North American Actuarial Journal. A paper on health care reform and ...- Authors: Ian G Duncan
- Date: Jan 2015
- Competency: External Forces & Industry Knowledge>Actuarial theory in business context
- Publication Name: Health Watch
- Topics: Health & Disability>Health care; Health & Disability>Health care quality; Health & Disability>Payment models; Public Policy
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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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Improving Outcomes Through Incentives: Using a Global Budget with Risk Sharing to Drive Cost Savings and Improved Quality
Improving Outcomes Through Incentives: Using a Global Budget with Risk Sharing to Drive Cost Savings and Improved Quality This article describes the results of three years of work by Blue Shield ...- Authors: Edward Cymerys
- Date: May 2013
- Competency: Relationship Management>Relationships and trust; Results-Oriented Solutions>Actionable recommendations; Strategic Insight and Integration>Management partnership; Technical Skills & Analytical Problem Solving>Innovative solutions
- Publication Name: Health Watch
- Topics: Health & Disability>Health care; Health & Disability>Health insurance; Health & Disability>Payment models
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Outpatient Facility Reimbursement
Outpatient Facility Reimbursement Review of reimbursement methodologies APGs, APCs, Medicare ASC, discount on charges, commercial hybrid, methods and trends in contracting, impact on trent, ...- Authors: Brian Small
- Date: Oct 2002
- Competency: External Forces & Industry Knowledge
- Publication Name: Health Watch
- Topics: Health & Disability>Payment models
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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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At the Intersection of Public Health and Actuarial Practice
At the Intersection of Public Health and Actuarial Practice An edited written interview with two actuaries and a public health professional on issues related to the intersection between the two ...- Authors: Barbara Zabielski
- Date: Oct 2017
- Competency: External Forces & Industry Knowledge>External forces and business performance; Professional Values>Public interest representation
- Publication Name: Health Watch
- Topics: Actuarial Profession>Professional associations; Health & Disability>Health care; Health & Disability>Payment models; Public Policy; Social Insurance>Medicaid
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Direct Primary Care: Good for What Ails Us
Direct Primary Care: Good for What Ails Us Discussion of direct primary care and how it helps with several challenges in health care today. DPC improves care coordination, improves outcomes, ...- Authors: Gayle Brekke
- Date: May 2016
- Competency: External Forces & Industry Knowledge>Actuarial theory in business context; Leadership>Thought leadership; Professional Values>Public interest representation; Technical Skills & Analytical Problem Solving>Innovative solutions
- Publication Name: Health Watch
- Topics: Economics>Health economics; Health & Disability>Health insurance; Health & Disability>Payment models
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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