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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 [...]

Case Study in Problem Solving: The Case of the Uncompetitive ACO

By | 2017-04-16T11:19:18+00:00 January 1st, 2017|Categories: Inspire|

I love a good challenge—particularly one that doesn’t have a clear path forward and seems daunting from the outset. Recently, a large health plan client presented us with just such a challenge: [...]

Republican Health Care Reform and Its Impact on Health Insurers

By | 2017-04-16T11:14:23+00:00 December 1st, 2016|Categories: Inspire|

Presidential Candidate Donald Trump promised to repeal and replace the Affordable Care Act (i.e., ACA or Obamacare). “On day one of the Trump Administration, we will ask Congress to immediately deliver a [...]