Description: Provides an overview of developments in the healthcare market including provider billing practices. Provides an overview of the Government Finance Officer’s Association (GFOA) in New York on Dec. 6, 2018

Description: In this video Mitchell Momanyi, FSA MAAA presents an informative breakdown of Medicare Advantage plans, delving into the intricacies of this alternative to traditional Medicare. Covering the inception of Medicare Advantage and its evolution, Momanyi explores the managed care companies offering Part C coverage, emphasizing the role of provider networks coordinated care. Concluding with key considerations for beneficiaries, Momanyi stresses the importance of weighing the pros and cons between Traditional Medicare and Medicare Advantage, while also emphasizing the evolving nature of the Medicare landscape and the regulatory nuances influencing enrollment decisions. Conributors: Mitchell Momanyi, FSA, MAAA, Deana Bell FSA, MAAA, Matt Emery, FSA, CERA, MAAA, Jon Forster, ASA, MAAA

Description: MHPAEA prohibits health plans from imposing financial requirements or treatment limitations on behavioral health benefits that are more restrictive than those applied to medical and surgical benefits. MHPAEA's regulations define treatment limitations to include nonquantitative treatment limitations (NQTLs), which are benefit design features that are not numerical, but otherwise limit the scope or duration of benefits.

Description: Discover the key components of value-based care (VBC) contracts and their impact on provider credibility. Learn about benchmarks, measurement period results, and the unique challenges providers face in managing insurance risk. Gain insights into reducing costs and aligning financial incentives in the US healthcare market.

Description: The Health Care Cost Institute (HCCI) recently released their annual health care cost and utilization report on February 13, 2020. This report illustrates employer group commercial health care costs and trends from 2014 – 2018.

Description: In this video led by Mitchell Momanyi, FSA, MAAA, the types of Medicare products available is discussed. This two major types are traditional Medicare and Medicare Advantage. It discusses how traditional Medicare encompasses Parts A and B, covering various inpatient and outpatient services but not long-term care or prescription drugs, which fall under Part D. The video details deductibles, cost-sharing structures, and options like Medigap plans that assist with Traditional Medicare’s out-of-pocket expenses. Mitchell emphasizes clarity and understanding while sharing his expertise in this comprehensive overview.

Description: Early in his career, Ehren Nagel, FSA, MAAA, scoured through podcasts and articles about predictive analytics, long suspecting this was a field with potential for him.

Description: This article is an update on the No Surprises Act, which is a U.S. Act aimed to reduce the risk that a person unexpectedly receives out of network charges for their health care visits.

Description: Yi-Ling Lin, FSA, MAAA, FCA, started the SOA’s Predictive Analytics Certificate Program to keep pace with the impact big data and predictive modeling is having on the health care industry

Description: Discussion and Opinion on how randomness affects measurement of provider contracting risk-sharing agreements