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Medicare Managed Care Organizations: Getting a Bigger Bang for the Buck
Medicare Managed Care Organizations: Getting a Bigger Bang for the Buck Panel discusses the effects of reduced payment levels to many Medicare managed care organizations. From the Record of the ...- Authors: Oscar Lucas, Peggy Tyndall
- Date: Jun 1998
- Competency: External Forces & Industry Knowledge>Actuarial methods in business operations; External Forces & Industry Knowledge>Actuarial theory in business context; Technical Skills & Analytical Problem Solving>Problem analysis and definition
- Publication Name: Record of the Society of Actuaries
- Topics: Economics>Health economics; Health & Disability>Health care; Health & Disability>Health insurance; Social Insurance>Medicare
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Profiling Physician Performance
Profiling Physician Performance Panelists discuss the methods HMOs employ to measure their providers' quality of care, outcomes, compliance with best practice guidelines, and cost ...- Authors: Joel C Hoffman, David Josephson, David Terry, John C Vataha, Kelly Myers
- Date: Jun 1999
- Competency: External Forces & Industry Knowledge>Actuarial methods in business operations; External Forces & Industry Knowledge>Actuarial theory in business context; Technical Skills & Analytical Problem Solving>Problem analysis and definition
- Publication Name: Record of the Society of Actuaries
- Topics: Actuarial Profession>Ethics; Economics>Health economics; Health & Disability>Health care; Health & Disability>Health care quality; Modeling & Statistical Methods>Regression analysis; Modeling & Statistical Methods>Simulation
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Validating a Novel Health Insurance Fraud Detection Method
Validating a Novel Health Insurance Fraud Detection Method This article describes methodologies for detection and deterrence of Medicare fraud. It also describes the validation of PRIDIT for ...- 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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Bariatric Surgery Holds Promise for Patients and for Payors
Bariatric Surgery Holds Promise for Patients and for Payors An economic analysis of bariatric surgery and health care costs supports the case for health plans to cover these procedures. Health ...- Authors: John Dawson, Pierre-Yves Cremieux, Arindam Ghosh
- Date: Jan 2011
- Competency: External Forces & Industry Knowledge>Actuarial methods in business operations; Results-Oriented Solutions>Actionable recommendations; Technical Skills & Analytical Problem Solving>Problem analysis and definition
- Publication Name: Health Watch
- Topics: Economics>Health economics; Experience Studies & Data; Health & Disability>Health risks; Modeling & Statistical Methods>Data mining