Plan Design Survey of the 2023 Individual Market
The macroeconomic environment is radically shifting as inflation ratchets up costs in every consumer category, including health care. AHP has already written extensively on broader inflation’s impact on trend, painting a more [...]
Intelligent Capitation Rates – Strategically Aligning Risk Adjustment with Costs
Introduction Aligning capitation rates with the line of business and risk selection of attributed members is an important component of provider contracting. Furthermore, doing so can illuminate hidden dynamics in financial reporting [...]
Time to Talk About Trend
There have been a number of market-changing dynamics over the last few years affecting healthcare with COVID unsurprisingly being the most notable. There was a steep decline in healthcare utilization in April [...]
My Recent Experience with Kaiser Health System
I moved from the east coast to the west coast seven years ago. My employer had several options to choose from for my healthcare benefits. In addition to options with national insurers, such [...]
Utilization Profiling for Care Management (and Profitability!)
Although there are many variables influencing healthcare costs, the most important are unit cost and utilization. Unit cost is subject to many constraints in relation to both healthcare and the broader economy. Much [...]
Pharmacy Provisions of the Inflation Reduction Act
Introduction I read the 725-page draft of the Deficit Reduction Act[1] so you don’t have to. Well, I skimmed 427 pages of it while focusing on the 164 pages which make significant [...]
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