Description: A divisive confrontation over health care pricing is almost inevitable over the next few years. What will ultimately happen is a political decision, not an actuarial one—but it will have major consequences for the trend in health care costs and the divergence between public and private insurance premiums.

Description: The “Getzen Model” is a set of linked formulas to facilitate projections of average medical care cost increases over the long run.

Description: Think about the last time you revamped your organization's case setup and billing processes. If nothing is coming to mind, you're not alone. Many insurance carriers haven't rethought the way they do case setup and billing in decades, and it's losing them hundreds of thousands of dollars in premium annually.

Description: On March 6, 2023, The Wall Street Journal hosted its Health Forum, a hybrid all-day event. The virtual meeting featured 11 different events. This white paper focuses on those events. The sessions were informative and fast-paced, with each one providing a quick hit of relevant and cutting-edge information around health care.

Description: Two years ago, before COVID-19 changed everything about how we provide and receive health care, telehealth was largely provided by third-party vendors to treat a narrow range of acute one-and-done conditions. The value proposition was simple: a fast and easy member experience would drive satisfaction and engagement; high member satisfaction and engagement would drive health plan savings and member retention. Clearly, from the perspective of utilization, telehealth—as a viable alternative to in-person care during a pandemic—worked. And with COVID-19’s nudge—or was that a push?—toward cultural acceptance, the health care system is in a better position to capitalize on telehealth’s original promise of expanded access, lower cost and better outcomes than it was two years ago. But in the wake of the pandemic, it is just as clear to us that if telehealth is to live up to its full potential, some changes are needed. The rest of this article presents five ideas for improving the delivery of telehealth going forward.

Description: The impact of Medicare on retiree medical. Issue No. 44.

Description: COVID has washed over healthcare like a tsunami—things have been tossed in all directions. According to Medicare actuaries, trends have been turned upside down in 2021, but will reverse back in 2023 as medical costs rebound. It is more prudent to base projections on long run trends for a period after the storm, extrapolating from 2026 forward, leaving the intervening turbulence (years 2022 -2025) mostly unspecified.

Description: In this report, we explore the impact of clustering using the Medical Expenditure Panel Study (MEPS) data for children (aged 5 to 17) to build a bridge between oral health and overall health using dental and medical expenditures. We include social determinants of health as cluster input variables using the Partitioning around Medoids (PAM) method to identify children and their families who could potentially benefit from population health management related to oral health.

Description: Chronic Kidney Disease (CKD) affects many lives and has a large impact on health systems around the world. To better understand and predict costs for insurance plan members with CKD in the United States, we built a new model of their individual costs. Our model is the first to explicitly model both the CKD stage transition process and the distribution of costs given those stages.

Description: Summary of the National Conference on Medical Costs, held in Washington, D.C. on June 28-29, 1967.