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Defining Best-In-Market Health Opportunities
perspective of defining strategies to identify best-in-market opportunities. From the Record of the Society ... Society of Actuaries, Vol. 24, No. 1. Consumer-driven health plans=CDHP;Group health plans;Health care costs;Health ...- Authors: Dale Yamamoto, Mindy S Kairey
- Date: Jun 1998
- Competency: External Forces & Industry Knowledge>Actuarial methods in business operations; External Forces & Industry Knowledge>Actuarial theory in business context; External Forces & Industry Knowledge>External forces and business performance; Strategic Insight and Integration>Effective decision-making; Technical Skills & Analytical Problem Solving>Innovative solutions
- Publication Name: Record of the Society of Actuaries
- Topics: Economics>Health economics; Health & Disability>Health care; Health & Disability>Health care quality; Health & Disability>Health insurance
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Validating a Novel Health Insurance Fraud Detection Method
detection and deterrence of Medicare fraud. It also describes the validation of PRIDIT for fraud detection ... Health care fraud;Predictive modeling;Medicare;Health insurance;Health economics;Health care costs;Data ...- 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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Palliative Care
Palliative Care This article from major US payers describes palliative care as a scaleable means of improving ... quality and reducing costs during serious and complex illness. Payment models=Health care payment models;Health ...- Authors: Randall Krakauer, Bruce Smith, Diane Meier, Torrie Fields
- Date: Nov 2016
- Competency: Leadership>Change management; Leadership>Influence; Leadership>Mentoring; Leadership>Professional network leverage; Leadership>Thought leadership; Results-Oriented Solutions>Actionable recommendations; Results-Oriented Solutions>Assess decision effectiveness; Strategic Insight and Integration>Big picture view; Strategic Insight and Integration>Effective decision-making
- Publication Name: Health Watch
- Topics: Economics>Health economics; Enterprise Risk Management>Systematic risk; Experience Studies & Data>Morbidity; Experience Studies & Data>Mortality; Health & Disability>Chronic health management - Health & Disability; Health & Disability>Health care quality; Health & Disability>Payment models
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Classical Thinking and Game Theory, Part II
Theory, Part II The second in a series of four articles that illustrate the “soft” approach of game theory ... theory using Thucydides’ master work, The History of the Peloponnesian War. By Carlos Fuentes Strategy;m ...- Authors: Carlos Eduardo Fuentes
- Date: Nov 2017
- Competency: Strategic Insight and Integration>Big picture view; Strategic Insight and Integration>Effective decision-making
- Publication Name: Innovators & Entrepreneurs
- Topics: Economics>Health economics; Economics>Macroeconomics
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Working With Health Care Coalitions
With Health Care Coalitions Panel discussion about ways can insurance carriers and health care coalitions ... processing;Data warehousing;Health care costs;Health care quality;Long-term care=LTC;Policyholder behavior; ...- Authors: Andrea B Castell, James P Hilferty, William H Rosenberg, Charles J Sherfey, Jean M Wodarczyk, Joseph H Rosmann
- Date: Oct 1986
- Competency: External Forces & Industry Knowledge>External forces and business performance; Leadership>Professional network leverage; Professional Values>Public interest representation; Strategic Insight and Integration>Effective decision-making; Technical Skills & Analytical Problem Solving>Problem analysis and definition
- Publication Name: Record of the Society of Actuaries
- Topics: Economics>Health economics; Health & Disability>Health information technology; Technology & Applications>Analytics and informatics
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What does ERM mean for Health Practitioners?
Practitioners? In this article, the author discusses the considerations and advantages of implementing an integrated ... health insurance company, and presents a summary of Aetna's experience with ERM as a case study.- 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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Design and Pricing of Tiered Network Health Plans
Design and Pricing of Tiered Network Health Plans This article discusses the advantages, logistical ... logistical concerns, and pricing formulas of implementing a TNHP, in which members pay less for treatment from ...- 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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Long-Term Disability Buyouts
Disability Buyouts Panel session exploring a variety of issues connected to long-term disability reserve ... Advantages and risks for buyers and sellers · Use of appropriate reserving assumptions · Possible ...- Authors: Michael Gabon, Stephen Mitchell, Daniel D Skwire
- Date: Oct 2000
- Competency: External Forces & Industry Knowledge>Actuarial methods in business operations; Professional Values>Practice expertise; Strategic Insight and Integration>Effective decision-making
- Publication Name: Record of the Society of Actuaries
- Topics: Economics>Health economics; Health & Disability>Disability insurance; Modeling & Statistical Methods>Stochastic models; Reinsurance>Reserving - Reinsurance