Description: While there are many approaches currently being taken to transform health care, to be successful, we know that leading and planning for quality improvement is a science. Data is the common denominator as healthcare organizations establish best-practices, and ultimately overcome unintended variation through strong analytic systems. Health care leaders require specialized data analysis education and training to hone their skills in understanding and managing clinical variation. The problem with unexplained variation in healthcare is that it negatively impacts clinical outcomes, increases the cost of care, and diminishes value for patients. In this session, Dr. Ted James (BIDMC and Harvard Medical School Faculty) will explain how actuaries can offer practical solutions that provide insights into variations in clinical practice that cannot be explained by differences in medical conditions or patient preferences.

Description: The purpose of this project was to create a tool that would allow actuaries to derive an understanding of the evidence for medical technologies that are provided through health plans.

Description: The ACA’s Medical Loss Ratio Provisions

Description: A Regulatory Perspective on Rate Review Before and After the Affordable Care Act

Description: Essential Health Benefits and Actuarial Value

Description: Medicare Advantage and ACA

Description: Introduction to the ACA @ 5 publication

Description: Details of an actuary’s project to help a local nonprofit agency improve its data analysis and customer service issues.

Description: The MACRA/QPP Payer Revenue Model is designed to provide Health Plans an estimate of the expected claim cost increase/decrease due to MACRA.

Description: The MACRA/QPP Provider Revenue Model is designed to provide an estimate of the revenue impact of the QPP (MIPS, AAPM) on a provider group or ACO, based on the required inputs and scenarios.