Description: A compilation of feedback from actuaries in the Health Section of the affects of the ACA.

Description: This article discusses the advantages, logistical concerns, and pricing formulas of implementing a TNHP, in which members pay less for treatment from providers who meet higher quality and cost-effectiveness standards.

Description: Overview of public health (responsibilities, funding, challenges) and discussion of the role actuaries can play in achieving population health goals.

Description: Presented at August 2011 46th Actuarial Research Conference. Discussion of research in progress which examines and validates the use of PRIDIT as a hospital quality measure. PRIDIT is an unsupervised learning technique developed as a fraud detection method.

Description: The editors of Health Watch have made health care reform the focus of the Sepctember 2009 issue, and provide an introduction to the issue's contents.

Description: Feature article with helpful hints on video conferencing and more!

Description: Wrap-up of publication and thank-yous.

Description: As health care changes, actuaries need to be able to understand developments and work with users of health plan information. Actuaries also must be a credible source of data. This article describes the efforts of the Society of Actuaries Task Force on Alternative Care to determine the effectiveness of alternative or integrative medicine, including nontraditional techniques such as chiropractic, acupuncture, massage therapy, and nutritional counseling.

Description: In the current value-based care marketplace, there are various reimbursement models that tie payments for care delivery to the quality of the care provided. The purpose is clear – change reimbursement to focus on value by rewarding better outcomes and lower spending. However, implementation it is complex, and many challenges emerge during this transition for both providers and payers.Providers often lack sophisticated actuarial capabilities or clear understanding of the connection between finance and clinical operations. For these reasons, they enter risk arrangements without knowing how to strategically manage and mitigate risks and fully transfer the reimbursement changes into clinical decisions. For payers, a truly viable value-based payment model that rewards the most valuable providers needs a multidisciplinary approach and a solid financial model. Such a model also requires transparency and a clear transitional road map for providers to encourage participation and collaboration. In this session, we will discuss lessons learned through case studies of working with both providers and payers on value-based care issues. We will illustrate the current state of the complex financial structures by presenting examples of value-based financial models, feasibility analyses, and strategies to design a payment model beneficial to both providers and payers. We will also explore the clinical collaboration necessary to make it all work, as well as present some best practice strategies to facilitate strong payer-provider collaboration.