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: Inspired by other financial savings products available to Canadians, this article describes a potential solution for financing future health expenses with the creation of a Registered Health Savings Account (RHSA). This solution has been thought on the basis of four premises : 1- Individual Accountability for Health Expenses; 2- Early Savings Leads to More Accumulation; 3-PreferredTax Treatment for Personal Health Savings; 4- Complementing current public and private health systems; Main elements of the RHSA are described (Contributions, Accumulation, Utilization of account, Management by financial institutions).RHSA'S expected balances and some other results under three scenarios (a person in good health, one in poor health, and one with unexpected death at age 45) are summarized in a table. Health expenses deducted yearly from RHSA's balance were estimated using total, per capita, provincial government health expenditures by age-band for Canada, in 2020, from the Canadian Institute of Heath Information’s (CIHI), which account for 71.8% of total expenditures, that is public + private. Thus 28.2% of total expenditures were used for private health expenditures, then forecasted to 2024 and projected using a 4% annual trend. Some objections to the solution explored were anticipated as well as some refutations to these objections.

Description: A proposal to reform the health care provider payment system through: a national fee schedule, shifting more reimbursements to primary care providers, better integration of hospital & physician fees, evidence based care, pay for performance, and a better provider risk sharing mechanism.

Description: Explanation of Medicare Advantage STAR rating program as it relates to payment rates for MA bids. Also describes important features of the program from an actuarial perspective, how the components of the STAR rating are calculated and implications and considerations for actuaries.

Description: CHCS is a nonprofit policy center focused on improving American health outcomes, particularly for low-income people, including payment & delivery system reform.

Description: What is the difference between a Single-Payer and Universal Health Care System, and how could the U.S. implement a system that would reduce the growth of medical costs while increasing quality.

Description: Individual Market and ACA Products Actuarial rating principals

Description: State Medicaid agencies have been implementing value-based payment (VBP) models for the last decade and are increasingly exploring advanced population-based payment (PBP) models that increase flexibility, predictability, and accountability for participating provider organizations. PBP models show promise in advancing Medicaid priorities, but are still in the early stages of development, and model design and implementation challenges remain. This article from the Center for Health Care Strategies explores the fundamentals of VBP and how PBP - a particular type of payment model - can help Medicaid agencies achieve goals related to care transformation and quality improvement, revenue stability, and controlling cost of care.