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Better Care Through Understanding the Customer Not Just the Patient
As actuaries in health care, we spend most of our time focused on reviewing claims, enrollment and clinical ... small fraction of their time in these facilities. This article explores what types of data are available ...- Authors: James Dolstad, Craig Cartossa, Justin Hartmann
- Date: Dec 2021
- Competency: Results-Oriented Solutions; Strategic Insight and Integration; Technical Skills & Analytical Problem Solving
- Publication Name: Health Watch
- Topics: Health & Disability; Health & Disability>Health care; Health & Disability>Health care quality; Health & Disability>Health insurance; Health & Disability>Health risks; Health & Disability>Payment models; Predictive Analytics; Health & Disability>Provider networks; Health & Disability>Provider risk; Predictive Analytics>Modeling techniques
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Possible Future of U.S. Healthcare
Possible Future of U.S. Healthcare What is the difference between a Single-Payer and Universal Health ... System, and how could the U.S. implement a system that would reduce the growth of medical costs while increasing ...- Authors: Roy Goldman
- Date: Nov 2019
- Competency: External Forces & Industry Knowledge; Strategic Insight and Integration
- Publication Name: Health Watch
- Topics: Health & Disability; Health & Disability>Health care; Health & Disability>Health care quality; 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 ...- 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
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Behavioral Economics: Overview and Healthcare Applications
Applications This article provides an overview of behavioral economic theory as it relates to health and welfare ... insurance plans and provides summaries of two sample applications of the theories: enrollment in health insurance ...- Authors: Randy P Herman, Tony Pistilli, Brian Plaskow, Jeffrey Chanin
- Date: Aug 2020
- Competency: External Forces & Industry Knowledge; Relationship Management; Results-Oriented Solutions; Strategic Insight and Integration; Technical Skills & Analytical Problem Solving
- Publication Name: Health Watch
- Topics: Economics; Economics>Behavioral economics; Economics>Health economics; Health & Disability; Health & Disability>Health care
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Restoring the Indifference Ideal: If It’s Not Adjusting for “Risk,” It’s Not “Risk Adjustment”
Restoring the Indifference Ideal: If It’s Not Adjusting for “Risk,” It’s Not “Risk Adjustment” ACA risk ... risk adjustment is intended to "bridge the gap" between allowed rates and actuarial rates. If risk adjustment ...- Authors: Greg Fann
- Date: Jun 2022
- Competency: Strategic Insight and Integration
- Publication Name: Health Watch
- Topics: Experience Studies & Data; Health & Disability>Health care
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Managed Care 3.0 Technology
Technology Actuaries are currently familiar with the impact of new technologies used primarily by clinicians ... such as new drugs and devices. The common theme emerging from many of the articles points to a technological ...- Authors: Joan Barrett, Sudha Shenoy
- Date: Jan 2021
- Competency: Strategic Insight and Integration
- Publication Name: Health Watch
- Topics: Health & Disability>Health care; Technology & Applications
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Biosimilars, Part 3: Humira Biosimilar Launches
3: Humira Biosimilar Launches The big event of 2023 is the launch of multiple Humira biosimilars, which ... with the arrival of Amgen’s Amjevita on the market. The launch of Amjevita kicks off the process of changing ...- Authors: Tony Pistilli, Greg Warren
- Date: Nov 2023
- Competency: External Forces & Industry Knowledge; Strategic Insight and Integration
- Publication Name: Health Watch
- Topics: Health & Disability; Health & Disability>Health care; Health & Disability>Health insurance; Public Policy; Public Policy; Public Policy
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Biosimilars, Part 4: The Financial Impact
Part 4: The Financial Impact Savings from biosimilars have accelerated significantly in the past few ... number of relatively recent biosimilar launches that can help to shape our expectations of the financial ...- Authors: Greg Warren, Tony Pistilli
- Date: Nov 2023
- Competency: External Forces & Industry Knowledge; Strategic Insight and Integration
- Publication Name: Health Watch
- Topics: Health & Disability; Health & Disability>Health care; Health & Disability>Health insurance; Public Policy; Public Policy; Public Policy
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Accountable Care Organizations: An Untapped Opportunity
various ACO models, limitations of the Medicare model for motivating change in the health care delivery system ... strategic priorities, attribution of members, meaurement, and the roles actuaries can play. Accountable ...- Authors: Jim Toole, Sara Teppema
- Date: Sep 2010
- Competency: External Forces & Industry Knowledge>External forces and business performance; Leadership>Thought leadership; Professional Values>Public interest representation; Strategic Insight and Integration
- Publication Name: Health Watch
- Topics: Enterprise Risk Management>Risk measurement - ERM; Enterprise Risk Management>Strategic risks; Health & Disability>Health care; Public Policy
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New Contract Medicare Star Ratings: Why The Sudden Cliff?
New Contract Medicare Star Ratings: Why The Sudden Cliff? On average, contracts receiving their first ... decreases their payments in the following calendar year. This article explores the disparity in Medicare Advantage ...- Authors: Suzanna-Grace Sayre, Danielle Beierle
- Date: Jan 2020
- Competency: External Forces & Industry Knowledge; Results-Oriented Solutions; Strategic Insight and Integration
- Publication Name: Health Watch
- Topics: Health & Disability; Health & Disability>Health care; Health & Disability>Health care quality; Health & Disability>Health insurance