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Our Value-Based Cup Runneth Over
Honestly, we’re not sure. (We just looked it up. It’s 37.) To make things more complicated, each contract ... of inconsistency across value-based contracts, let’s dive into one important piece of these arrangements: ...- Authors: Daniel Reck (Dan), Lisa Swan, Sam Johnmeyer
- Date: Aug 2022
- Competency: Communication; External Forces & Industry Knowledge; Strategic Insight and Integration
- Publication Name: Health Watch
- Topics: Enterprise Risk Management>Risk appetite; Enterprise Risk Management>Risk measurement - ERM; Health & Disability>Chronic health management - Health & Disability; Health & Disability>Health care quality; Health & Disability>Health insurance; Health & Disability>Payment models; Health & Disability>Provider risk
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Provider Risk-Sharing and Random Noise
paid to the provider. Table 1 breaks this down for dif- ferent size groups. Table 1 Sample Random Variation ... HMOs. Managed Care, Dec. 1, 2000. https://www .managedcaremag.com/archives/2000/12/downstream-without-paddle ...- 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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Understanding the Medical Stop-Loss Market
high-dollar medical claims that exhaust the company’s profit for the year.[1] This article details the medical ... these programs operate effectively to the purchaser’s benefit, even on claims below the stop-loss attachment ...- Authors: Keith Passwater, Peter Robinson, David Nelson
- Date: Jun 2022
- Competency: External Forces & Industry Knowledge
- Publication Name: Health Watch
- Topics: Reinsurance; Health & Disability>Provider risk
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AI and EMRs: Pioneering the New Frontier in Healthcare Actuarial Practice
• Uncovering Risk Score Capture Opportunies: Ulizing EMR data can reveal addional risk score ... mechanism%20for%20achieving%20this%20goal 2) Zhao, S. (2023, August). The Next Horizon of Value-based Care: ...- Authors: Netanel Lederer
- Date: May 2024
- Competency: External Forces & Industry Knowledge; Strategic Insight and Integration; Technical Skills & Analytical Problem Solving
- Publication Name: Innovators & Entrepreneurs
- Topics: Health & Disability; Health & Disability>Health care; Health & Disability>Health information technology; Health & Disability>Provider risk; Health & Disability>Electronic medical record
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Give Me Some Credibility: Addressing the Challenge of Volatility in Value-Based Contracts—Part 2
improve credibility enough that a larger provider's own prior period experience can be used directly, ... for providers to trust. Questions of the form “it's not clear or fair that I should be measured based ...- Authors: Maria Knox, James Pisko, Keith Passwater
- Date: May 2023
- Competency: External Forces & Industry Knowledge; Results-Oriented Solutions; 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; Predictive Analytics; Health & Disability>Provider networks; Health & Disability>Provider risk; Predictive Analytics>Modeling techniques
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Money Matters: Making Medicaid Payment More Effective Through Population-Based Payment
multiple ways to set rates—which can be based on a state’s goals, data availability, and its desire/ability to ... M. Silverman, L. Burgette, M. E. Vaiana, and M. S. Ridgely. “Are Value-Based Incentives Driving Behavioral ...- Authors: Anne Smithey, Kelsey Brykman
- Date: May 2023
- Competency: External Forces & Industry Knowledge
- Publication Name: In The Public Interest
- Topics: Health & Disability; Health & Disability>Health care quality; Health & Disability>Payment models; Health & Disability>Public financing - Health & Disability; Social Insurance; Social Insurance>Medicaid; Health & Disability>Provider risk