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Managed Care 3.0 Technology
Managed Care 3.0 Technology Actuaries are currently familiar with the impact of new technologies used ... used primarily by clinicians and health care providers, such as new drugs and devices. The common theme ...- 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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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 ... information is captured while patients are in health care facilities. Yet most people spend only a small fraction ...- 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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Accountable Care Organizations: An Untapped Opportunity
Accountable Care Organizations: An Untapped Opportunity Since health care reform has made accountable ... accountable care organizations a hot topic, an SOA workgroup is addressing relevant questions, including provider ...- 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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Restoring the Indifference Ideal: If It’s Not Adjusting for “Risk,” It’s Not “Risk Adjustment”
medical claim cost differences. For example, as health care costs materially increase with age, age should be ... indifference ideal. The World of ACA The Affordable Care Act (ACA) created a paradigm shift. In the ACA world ...- 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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Possible Future of U.S. Healthcare
difference between a Single-Payer and Universal Health Care System, and how could the U.S. implement a system ... quality. Medicare for All, Payment reforms=Health care payment reforms 11/22/2019 12:00:00 AM ...- 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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Behavioral Economics: Overview and Healthcare Applications
Behavioral Economics: Overview and Healthcare Applications This article provides an overview of ... created by the Patient Protection and Affordable Care Act, and product design considerations in light ...- 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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New Contract Medicare Star Ratings: Why The Sudden Cliff?
New Contract Medicare Star Ratings: Why The Sudden Cliff? On average, contracts receiving their first star rating receive ... Rating cliff? Value-based insurance design, Managed care 1/6/2020 12:00:00 AM ...- 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
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Provider Risk-Sharing and Random Noise
infrastructure. Pricing actuaries will need to estimate the direct effect of random fluctuations, the indirect effect ... Some- times Shi Accountability to HMOs. Managed Care, Dec. 1, 2000. https://www .managedcaremag.com ...- 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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Biosimilars, Part 3: Humira Biosimilar Launches
patients everywhere. prescription drug costs, health care payment reforms, medical expenses By Gregory Warren ... inclusion in formularies so patients can have the care access they need. To remove Humira from your formulary ...- 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
Biosimilars, Part 4: The Financial Impact Savings from biosimilars have accelerated significantly ... year’s big event. prescription drug costs, health care payment reforms, medical expenses By Gregory Warren ...- 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