The Cost-Sharing Reduction Paradox: Defunding Would Help ACA Markets, Not Make Them Implode

By | 2017-08-09T11:17:54+00:00 August 8th, 2017|Categories: Inspire|

The health insurance industry and interested stakeholders waited anxiously last week for a decision from the Trump administration that many believe could have significant negative implications on the individual health insurance [...]

Building Actuarial Cost Models from Health Care Claims Data for Strategic Decision-Making

By | 2017-06-21T11:32:21+00:00 June 21st, 2017|Categories: Inspire|

Introduction Health care spending across the country generates billions of claim records annually. Claim records originate as a form of invoice for health care providers to bill for services rendered. Providers [...]

The Forgotten and Undervalued Resource: Care Management

By | 2017-04-12T12:17:55+00:00 April 12th, 2017|Categories: Inspire|Tags: , |

In many of our recent client situations we encounter a surprising lack of awareness and concern about the importance of care management and how it might directly impact the project we are [...]

Saving the Exchanges? A Case for the Provider-Owned Health Plan

By | 2017-04-12T12:19:45+00:00 April 6th, 2017|Categories: Inspire|Tags: , |

Introduction There is a lot of talk about the future of Obamacare. Many fear the exchanges are in a death spiral and, if left to current market forces, will eventually implode. Guaranteed [...]

Data Intermediaries: Pulling Insights from Confidential Data

By | 2017-04-12T12:50:00+00:00 March 28th, 2017|Categories: Inspire|

Over the past several years, I have had the privilege of providing actuarial support to health systems pursuing alternative payment models and value-based reimbursement arrangements. In some cases, the health system was [...]