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Restoring the Indifference Ideal: If It’s Not Adjusting for “Risk,” It’s Not “Risk Adjustment”
Restoring the Indifference Ideal: If It’s Not Adjusting for “Risk,” It’s Not “Risk Adjustment” ACA risk adjustment ... Family Foundation (KFF) states it this way, “The ACA’s risk adjustment program is intended to reinforce market ...- 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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Medicare Supplement and FASB’s Long-Duration Targeted Improvements Project Part II: Conclusions
Medicare Supplement and FASB’s Long-Duration Targeted Improvements Project ... Board (FASB) adopted significant revisions to the U.S. GAAP insurance accounting literature, via Accounting ...- Authors: Rowen Bell
- Date: Aug 2021
- Competency: External Forces & Industry Knowledge
- Publication Name: Health Watch
- Topics: Financial Reporting & Accounting; Financial Reporting & Accounting>Generally Accepted Accounting Principles [GAAP]; Health & Disability; Health & Disability>Health insurance
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The Rise of Python: Powerful, Robust Calculation Software
calculations Policyholder asset look-through Lapse and mortality investigations Analyzing past policyholder performance ... it after his favorite comedy troupe, Monty Python’s Flying Circus. He had observed that computers were ...- Date: Aug 2021
- Competency: Results-Oriented Solutions
- Publication Name: Health Watch
- Topics: Modeling & Statistical Methods; Technology & Applications>Analytics and informatics; Technology & Applications>Business intelligence; Technology & Applications>Computer science; Technology & Applications>Software; Technology & Applications>Artificial intelligence & machine learning; Technology & Applications>Automation; Technology & Applications>Finance transformation; Technology & Applications>Visualization
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Understanding Health in the Big Picture
modifiable contributors to health outcomes.[3] The U.S. Department of Health and Human Services (HHS), in ... health outcomes. Am J Prev Med 49, no. 6:961–969. [4] U.S. Department of Health and Human Services. Social ...- Authors: Jill Van Den Bos, Stoddard Davenport
- Date: Aug 2021
- Competency: External Forces & Industry Knowledge
- Publication Name: Health Watch
- Topics: Health & Disability>Health care; Health & Disability>Health care quality; Health & Disability>Health risks
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Telehealth at a Crossroads
care during a pandemic—worked. And with COVID-19’s nudge—or was that a push?—toward cultural acceptance ... in a better position to capitalize on telehealth’s original promise of expanded access, lower cost and ...- Authors: Kirsten Staveland, Brian Parkinson
- Date: Dec 2021
- Competency: External Forces & Industry Knowledge
- Publication Name: Health Watch
- Topics: Health & Disability; Public Policy
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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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Navigate through Risk-Based Capital with Success
operations, taking into consideration the insurer’s size and risk profile.”[1] Regulators use RBC to assess ... authority to take control of the insurer if the insurer’s RBC falls below regulatory levels. These levels provide ...- Authors: Karena Weikel, Jinjun (Sophia) Yu
- Date: Dec 2021
- Competency: Strategic Insight and Integration
- Publication Name: Health Watch
- Topics: Actuarial Profession; Finance & Investments
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Response to March 2021 Practice Note on ASOP 6
than the consulting actuary’s statement of opinion on a private employer’s financial statement disclosure ... closed, they remain a material liability for many U.S. companies and public sector entities. As is so often ...- Authors: Charles Edwards
- Date: Aug 2022
- Competency: Technical Skills & Analytical Problem Solving
- Publication Name: Health Watch
- Topics: Experience Studies & Data>Morbidity; Health & Disability>Health care
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Better Care Through Understanding the Customer Not Just the Patient
types of data exist outside a health plan or provider’s walls that would enable us to develop a more holistic ... data sources that can help inform us of a member’s needs and wants. The first two are publicly available ...- 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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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