Description: Can Direct-to-Provider Contracting Achieve Value-Based Care for Employer-Sponsored Plans? Direct-to-provider contracting is a strategy in which a self-insured entity negotiates a contract directly with a provider of healthcare services rather than through a third-party administrator (TPA), often with the goal of driving value-based care. This article discusses the considerations for employers and providers with direct-to-provider contracting.

Description: Article describes enhanced primary care models and provides citations on whether or not health care savings have been achieved.

Description: The International Actuarial Association Health Section, the Society of Actuaries International Section, and American Academy of Actuaries (AAA) published the report “International Health Care Funding 2020”. This article highlights the features of the report.

Description: Compares the healthcare system of the US to the universal systems of selected other countries. Relies primarily on information compiled annually by The Commonwealth Fund. Will give the reader an understanding of the difference between universal healthcare, socialized medicine, and single-payer healthcare and how various national systems fall within these categories.

Description: CHCS is a nonprofit policy center focused on improving American health outcomes, particularly for low-income people, including payment & delivery system reform.

Description: Discussion of how to mature value-based contracts between health insurers and provider organizations to improve population health and financial sustainability. Centers around contract parameter consistency, revenue predictability and risk assessment. Intended audience are health plan and ACO actuaries and leaders. Authors are writing from the provider perspective in value-based contracts.

Description: State Medicaid agencies have been implementing value-based payment (VBP) models for the last decade and are increasingly exploring advanced population-based payment (PBP) models that increase flexibility, predictability, and accountability for participating provider organizations. PBP models show promise in advancing Medicaid priorities, but are still in the early stages of development, and model design and implementation challenges remain. This article from the Center for Health Care Strategies explores the fundamentals of VBP and how PBP - a particular type of payment model - can help Medicaid agencies achieve goals related to care transformation and quality improvement, revenue stability, and controlling cost of care.

Description: What is the difference between a Single-Payer and Universal Health Care System, and how could the U.S. implement a system that would reduce the growth of medical costs while increasing quality.

Description: The article provides insights about the need for revolutionary actuaries in Saudi Arabia due to the reform that is happening across the kingdom under all sectors. Then I talk briefly about the health sector and the transformation that is happing in the sector, and how qualified health actuaries can contribute to this health reform.

Description: Review of reimbursement methodologies APGs, APCs, Medicare ASC, discount on charges, commercial hybrid, methods and trends in contracting, impact on trent, benchmarking. Issue No. 44.