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Profiling Physician Performance
Profiling Physician Performance Panelists discuss the methods HMOs employ to measure their providers' quality of care, outcomes, compliance with best practice guidelines, and cost ...- Authors: Joel C Hoffman, David Josephson, David Terry, John C Vataha, Kelly Myers
- Date: Jun 1999
- Competency: External Forces & Industry Knowledge>Actuarial methods in business operations; External Forces & Industry Knowledge>Actuarial theory in business context; Technical Skills & Analytical Problem Solving>Problem analysis and definition
- Publication Name: Record of the Society of Actuaries
- Topics: Actuarial Profession>Ethics; Economics>Health economics; Health & Disability>Health care; Health & Disability>Health care quality; Modeling & Statistical Methods>Regression analysis; Modeling & Statistical Methods>Simulation
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Modeling Anti-selective Lapse and Optimal Pricing in Individual and Small Group Health Insurance
Modeling Anti-selective Lapse and Optimal Pricing in Individual and Small Group Health Insurance A new health insurance pricing model takes external market prices into account, as well as ...- Authors: D Wei
- Date: Feb 2010
- Competency: External Forces & Industry Knowledge>Actuarial methods in business operations; Results-Oriented Solutions>Actionable recommendations; Technical Skills & Analytical Problem Solving>Incorporate risk management
- Publication Name: Health Watch
- Topics: Economics>Health economics; Health & Disability>Health risks; Modeling & Statistical Methods; Technology & Applications>Analytics and informatics
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Validating a Novel Health Insurance Fraud Detection Method
Validating a Novel Health Insurance Fraud Detection Method This article describes methodologies for detection and deterrence of Medicare fraud. It also describes the validation of PRIDIT for ...- Authors: Robert D Lieberthal, Elias
- Date: Aug 2018
- Competency: External Forces & Industry Knowledge>Actuarial methods in business operations; Strategic Insight and Integration>Effective decision-making; Technical Skills & Analytical Problem Solving>Incorporate risk management; Technical Skills & Analytical Problem Solving>Innovative solutions; Technical Skills & Analytical Problem Solving>Problem analysis and definition; Technical Skills & Analytical Problem Solving>Process and technique refinement
- Publication Name: Risk Management
- Topics: Economics>Health economics; Enterprise Risk Management; Health & Disability>Health care; Health & Disability>Health care quality; Health & Disability>Health information technology; Health & Disability>Health insurance; Health & Disability>Public financing - Health & Disability; Modeling & Statistical Methods>Data mining; Predictive Analytics
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From The Editor
From The Editor A look into the issues’ contents. By Carlos Fuentes Models;Strategy;Artificial intelligence;Passion;Product development;Predictive modeling;Entrepreneurship By Carlos Fuentes What ...- Authors: Carlos Eduardo Fuentes
- Date: Nov 2017
- Competency: External Forces & Industry Knowledge>Actuarial methods in business operations; External Forces & Industry Knowledge>General business skills; Leadership>Thought leadership; Strategic Insight and Integration>Big picture view; Strategic Insight and Integration>Strategy development; Technical Skills & Analytical Problem Solving>Problem analysis and definition
- Publication Name: Innovators & Entrepreneurs
- Topics: Actuarial Profession>Management skills; Economics>Health economics; Economics>Macroeconomics; Modeling & Statistical Methods>Estimation methods
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Design and Pricing of Tiered Network Health Plans
Design and Pricing of Tiered Network Health Plans This article discusses the advantages, logistical concerns, and pricing formulas of implementing a TNHP, in which members pay less for treatment ...- Authors: Peter Horman
- Date: May 2009
- Competency: External Forces & Industry Knowledge>Actuarial methods in business operations; Results-Oriented Solutions; Strategic Insight and Integration>Effective decision-making; Technical Skills & Analytical Problem Solving>Process and technique refinement
- Publication Name: Health Watch
- Topics: Economics>Health economics; Health & Disability>Health care quality; Modeling & Statistical Methods
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What does ERM mean for Health Practitioners?
What does ERM mean for Health Practitioners? In this article, the author discusses the considerations and advantages of implementing an integrated enterprise risk management program for a health ...- Authors: Max Rudolph
- Date: Feb 2010
- Competency: External Forces & Industry Knowledge>External forces and business performance; Relationship Management>Staff management and motivation; Results-Oriented Solutions; Strategic Insight and Integration>Effective decision-making; Technical Skills & Analytical Problem Solving>Incorporate risk management
- Publication Name: Health Watch
- Topics: Economics>Health economics; Enterprise Risk Management; Modeling & Statistical Methods>Forecasting
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Bariatric Surgery Holds Promise for Patients and for Payors
Bariatric Surgery Holds Promise for Patients and for Payors An economic analysis of bariatric surgery and health care costs supports the case for health plans to cover these procedures. Health ...- Authors: John Dawson, Pierre-Yves Cremieux, Arindam Ghosh
- Date: Jan 2011
- Competency: External Forces & Industry Knowledge>Actuarial methods in business operations; Results-Oriented Solutions>Actionable recommendations; Technical Skills & Analytical Problem Solving>Problem analysis and definition
- Publication Name: Health Watch
- Topics: Economics>Health economics; Experience Studies & Data; Health & Disability>Health risks; Modeling & Statistical Methods>Data mining