Description: This article contains a condensed summary and excerpt from the fourth white paper in the Commercial Health Care: What’s Next? series.

Description: Discussion of the impact of the ACA on RBS and required surplus for a health plan

Description: Remain a competitor in health insurance with value, knowing the competition, and using external experts Issue No. 37.

Description: Current Status of managing costs & increasing costs, Future Direction of Consumerism, technology and defined contribution health plans. Issue No. 39.

Description: This article will consider several issues arising from ACO budgeting and pricing of stoploss coverage, including: 1) attribution of members; 2) claim carve outs; 3) ambiguous stoploss terms; 4) providers gaming the system and 5) credibility of data.

Description: Part II of a two-part series discussing individual market evolution from before the ACA through President Trump's first term.

Description: An edited written interview with two actuaries and a public health professional on issues related to the intersection between the two fields.

Description: Argues that reinstatement of CSR (cost-sharing reduction) reimbursements by federal government will have destabilizing effect on individual market.

Description: This article makes organizations entering the MA market aware of the star rating climate, as well as short- and long-term star rating & revenue considerations.

Description: Recent health care reform activity has highlighted the importance of Clinical Integration in improving the quality, safety, efficiency and reimbursement infrastructure of the health care system. This article discusses relevance and implication of regulatory measures, implementation and data issues, and provides an end-to-end example.