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Considerations for Surplus Determination under ACA
There are five separate actionable outcomes (see Table 1). For a health care insurer that is between 200 ... He can be reached at richard.tash@optum. com Table 1: Risk-Based Capital authoritative action Outcomes ...- Authors: Daniel Pribe, Richard Tash, David M Tuomala
- Date: May 2014
- Competency: External Forces & Industry Knowledge>External forces and business performance; Leadership>Thought leadership; Professional Values>Practice expertise; Strategic Insight and Integration>Strategy development; Technical Skills & Analytical Problem Solving>Problem analysis and definition
- Publication Name: Health Watch
- Topics: Health & Disability>Health care; Health & Disability>Health insurance; Public Policy
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Pricing Issues Resulting from Budget Setting and Stoploss in ACO Arrangements
Pricing Issues Resulting ... In n e R S o f T h e h e A lT h W A T C h A R T IC l e C o n T e S T 30 | ... decrease in quality. The insurer and ACO provider(s) should develop clear definitions of quality and ...- 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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ERM Opportunities for Health Practitioners
ERM Opportunities for Health Practitioners Summary of recent SOA-sponsored research on Enterprise ... appropriate for them to take a seat at the ERM table and be considered to head this team. As with any ...- Authors: Max Rudolph
- Date: May 2010
- Competency: Communication; External Forces & Industry Knowledge>External forces and business performance; Leadership>Change management; Technical Skills & Analytical Problem Solving>Problem analysis and definition
- Publication Name: Health Watch
- Topics: Actuarial Profession>Alternative careers; Actuarial Profession>Best practices; Enterprise Risk Management; Enterprise Risk Management>Compliance
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The Medicare Advantage 5-Star Rating Program and Its Implications for Actuaries
payment percentages by star rat- ing are shown in the table in Figure 1. The percentage of the savings a plan ... rebate percentages by star rating are shown in the table in Figure 2. Special rules apply to low-enrollment ...- Authors: Adrian L Clark, Gabriela Dieguez, Bradley James Piper
- Date: May 2012
- Competency: External Forces & Industry Knowledge>External forces and business performance; Results-Oriented Solutions>Actionable recommendations; Strategic Insight and Integration>Strategy development; Technical Skills & Analytical Problem Solving>Problem analysis and definition
- Publication Name: Health Watch
- Topics: Health & Disability>Health insurance; Health & Disability>Payment models; Public Policy
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Selling Health Insurance Across State Lines
implementation of the ACA. The ACA allows the U.S. Office of Personnel Management (OPM) to oversee ... of America, the District of Colum- bia and the U.S. Territories. 2 From Kaiser Health News: State coverage ...- Authors: Lawrence Mitchell
- Date: Aug 2017
- Competency: External Forces & Industry Knowledge>External forces and business performance; Professional Values>Public interest representation; Strategic Insight and Integration>Big picture view; Strategic Insight and Integration>Influence decisions; Technical Skills & Analytical Problem Solving>Problem analysis and definition
- Publication Name: In The Public Interest
- Topics: Health & Disability>Health insurance; Public Policy
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A Road Less Traveled
A Road Less Traveled The article described recent major advances in measurement of health programs ... pro- grams are dual challenges: (1) a fragmented U.S. health system; and (2) a payment system focused ...- Authors: Greger J Vigen
- Date: Jul 2014
- Competency: External Forces & Industry Knowledge>External forces and business performance; Technical Skills & Analytical Problem Solving>Problem analysis and definition
- Publication Name: In The Public Interest
- Topics: Health & Disability>Health care
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Cancer Diagnostics 2.0 - What Does It Mean for Insurers?
Cancer Diagnostics 2.0 - What Does It Mean for Insurers? The article describes medical progress ... so far one technology has been approved by the U.S. Food and Drug Administration (FDA) for evaluating ...- Authors: Karin Neelsen
- Date: Jul 2017
- Competency: External Forces & Industry Knowledge>External forces and business performance; Technical Skills & Analytical Problem Solving>Problem analysis and definition
- Publication Name: Reinsurance News
- Topics: Health & Disability>Critical illness insurance