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As more health plans utilize Accountable Care Organizations (i.e., ACOs) as part of their network operations, ACO performance assessment is becoming more important. Plans should thoroughly assess an ACO before they agree to contracting. [...]

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: they had [...]

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 full repeal [...]

Medical claims reserving has remained relatively unchanged for decades. The traditional approach to calculating IBNR reserves, that will be defined later in this article, has stayed the same even though technology and computing power [...]

Recognized as a firm deeply engaged in the regulatory and technical aspects of the Patient Protection and Affordable Care Act (ACA), we were invited to provide comments and influence President Obama’s final regulatory enhancements [...]

A health plan’s transition from fee-for-service to value-based reimbursement (i.e., VBR) can be very challenging. This article provides a pathway to successful implementation of these programs and summarizes how the implementation might be accomplished, [...]