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Building Actuarial Cost Models From Health Care Claims Data
across the country generates billions of claim records annually. Claim records originate as a form of invoice ... Providers submit the claims to the liable payer (typically a health plan, government agency or the patient) ...- Authors: William Bednar
- Date: Jun 2017
- Competency: External Forces & Industry Knowledge>Actuarial methods in business operations; Results-Oriented Solutions>Actionable recommendations; Strategic Insight and Integration>Influence decisions; Technical Skills & Analytical Problem Solving>Innovative solutions; Technical Skills & Analytical Problem Solving>Problem analysis and definition
- Publication Name: Health Watch
- Topics: Health & Disability>Health insurance; Technology & Applications>Analytics and informatics; Technology & Applications>Business intelligence
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Regulatory Monitoring of Individual Health Insurance Policy Experience
Regulatory Monitoring of Individual Health Insurance Policy Experience This paper was prepared to facilitate ... with the New York State Insurance Department concerning price regulation and the application of minimum ...- Authors: Application Administrator, John Cumming, Richard Diamond
- Date: Oct 1982
- Competency: Technical Skills & Analytical Problem Solving>Innovative solutions
- Publication Name: Transactions of the SOA
- Topics: Health & Disability>Health insurance
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Defined Contribution Health Plans
strategies of interest to employees, as well as the impact of defined contribution plans on the health insurance ... third-party administration business. From the Record of the Society of Actuaries, Volume 28, No. 2, Session ...- Authors: Lindsay Resnick, Beth Grice, Penny Hahn, David M Tuomala
- Date: Jun 2002
- Competency: Technical Skills & Analytical Problem Solving>Innovative solutions
- Publication Name: Record of the Society of Actuaries
- Topics: Health & Disability>Health insurance
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Benchmarking to Maximize Managed Care Performance
Benchmarking to Maximize Managed Care Performance How benchmarking actual performance to ... a published source is a useful tool in assessing the value added by a particular program or MCO, Issue ...- Authors: Susan McQuillian
- Date: Aug 2000
- Competency: Technical Skills & Analytical Problem Solving>Innovative solutions
- Publication Name: Health Watch
- Topics: Health & Disability>Health insurance
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Population Risk Management: Identifying High-Risk Members to Reduce Costs
to the straight laser option. This is because the aggregating specific deductible applies to the group ... group in total, while the laser is applied strictly to an individual. Again, this point can be simply illustrated ...- Authors: Ian G Duncan
- Date: Jun 2002
- Competency: Technical Skills & Analytical Problem Solving>Innovative solutions
- Publication Name: Health Watch
- Topics: Health & Disability>Health insurance
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Defining Best-In-Market Health Opportunities
perspective of defining strategies to identify best-in-market opportunities. From the Record of the Society ... Society of Actuaries, Vol. 24, No. 1. Consumer-driven health plans=CDHP;Group health plans;Health care costs;Health ...- Authors: Dale Yamamoto, Mindy S Kairey
- Date: Jun 1998
- Competency: External Forces & Industry Knowledge>Actuarial methods in business operations; External Forces & Industry Knowledge>Actuarial theory in business context; External Forces & Industry Knowledge>External forces and business performance; Strategic Insight and Integration>Effective decision-making; Technical Skills & Analytical Problem Solving>Innovative solutions
- Publication Name: Record of the Society of Actuaries
- Topics: Economics>Health economics; Health & Disability>Health care; Health & Disability>Health care quality; Health & Disability>Health insurance
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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 ... Quality This article describes the results of three years of work by Blue Shield of California to collaborate ...- 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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Calibrating Risk Score Model with Partial Credibility
Calibrating Risk Score Model with Partial Credibility This article describes a method that can ... when re-fitting a risk score model to a population of only moderate size. Learn how to use concepts like ...- Authors: Sheamus Parkes, Bradley Armstrong
- Date: Jul 2015
- Competency: Technical Skills & Analytical Problem Solving>Innovative solutions; Technical Skills & Analytical Problem Solving>Problem analysis and definition; Technical Skills & Analytical Problem Solving>Process and technique refinement
- Publication Name: Predictive Analytics and Futurism Newsletter
- Topics: Health & Disability>Health care; Health & Disability>Health insurance; Modeling & Statistical Methods>Bayesian methods; Modeling & Statistical Methods>Data mining; Modeling & Statistical Methods>Estimation methods; Modeling & Statistical Methods>Regression analysis; Predictive Analytics
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Chicago Health Insurance Market
recent developments in the Chicago health care delivery system, the involvement of Chicago area HMOs, PPOs ... insurers in the financing and delivery of health care services, and issues unique to the Chicago market ...- Authors: Lowell W Johnson, Ronald A Metzler, Kenneth J Morrissey, Frank E E Nicholson, Donald M Peterson
- Date: Oct 1986
- Competency: External Forces & Industry Knowledge>External forces and business performance; Technical Skills & Analytical Problem Solving>Innovative solutions; Technical Skills & Analytical Problem Solving>Process and technique refinement
- Publication Name: Record of the Society of Actuaries
- Topics: Health & Disability>Health insurance
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Mining Electronic Health Records to Achieve the Triple Aim
Mining Electronic Health Records to Achieve the Triple Aim Mining Electronic Health Records using a ...- Authors: Lillian Dittrick
- Date: Mar 2017
- Competency: Technical Skills & Analytical Problem Solving>Innovative solutions
- Publication Name: Health Watch
- Topics: Health & Disability>Health insurance; Predictive Analytics