Description: This article contains excerpts from the first three articles that were released through the strategic initiative - Commercial Health Care: What’s Next?

Description: As providers are considering accountable and value based care models, it is critical to strategically think through how to achieve a sustainable business model into the future. This requires actuarial and clinical/provider capabilities to assess the care management and financial levers to help a client through the transition.

Description: An actuarial model that provides financial incentives to providers to offer patients an approach that can reverse chronic disease and reduce health care costs

Description: We propose using premiums and tax revenue to fund high-cost individuals in the Individual ACA market.

Description: Mental health spending has reached $147 billion in the United States with demand only increasing greatly impacting society as nearly 1 in 5 experience these issues. There are even more indirect costs associated with mental health causing a national crisis surpassing 1 percent of the GDP. These costs coupled with the severe lack of licensed clinicians calls for an innovative solution. Through years of development and completion of a randomized controlled trial, Prevail has built and validated a low-cost, scalable solution. Prevail's clinically proven digital mental health treatment provides increased access to care while reducing overall health costs. Private and public payors should being reimbursing this model and offering it to their members.

Description: The article is a case study of various actuarial concepts invovled in the design and implementtion of the AQC - a global budget provider payment arrangement implemented by Blue Cross Blue Shield of MA.