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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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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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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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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
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Responsible Machine Learning: Living Up to Our Professional Code of Conduct, ASOPs, and Corporate Requirements
selecting that technology.[1] Numerous use cases for AI’s impact on the health care industry are emerging on ... they have significant room for improvement. Duke’s Margolis Center for Health Policy released a paper ...- Authors: James Dolstad, Abby Steele
- Date: Aug 2022
- Competency: Professional Values; Results-Oriented Solutions; Strategic Insight and Integration
- Publication Name: Health Watch
- Topics: Health & Disability>Health insurance; Predictive Analytics