Are Copper Plans the Solution for Affordability?
President Trump introduced the concept of a copper plan as a solution to healthcare affordability. But is it a solution? Yes, copper premiums will be lower than what is currently offered...
One Size Doesn’t Fit All: Industry-Based Utilization Patterns in Health Insurance
Designing health benefits as if they were one-size-fits-all is a bit like issuing steel-toed boots to accountants or medical scrubs to long-haul truckers—it sounds equitable until you look at the bill.
Is a Tax Credit System the Cure for U.S. Healthcare?
The U.S. healthcare system, marked by extraordinary technological capability and deeply rooted inequities, has reached a critical inflection point.
Is Self-Funding the Right Move?
How Employers Should Evaluate the Shift from Fully Insured Health Plans. Self-funding is an alternative approach where employers directly manage and fund healthcare claims, allowing greater transparency, flexibility, and control over healthcare costs...
Denial Rates: Fact or Fiction?
The killing of the CEO of a major health plan has again highlighted the issue of denials and denial rates in today’s healthcare marketplace. It is fairly common in today’s marketplace to criticize those plans with higher than average denial rates.
Health Insurer Claim Denial Rates and the Kaiser Outlier
Following the recent shooting death of UnitedHealthcare’s (UHC) CEO, claim denial rates have recently become a highly scrutinized statistic in the news and on social media.
The Hidden Cost of Trend Leveraging
Trend leveraging is an issue commonly overlooked when developing premium rates for new plan years. Trend leveraging occurs when rising healthcare costs result in more plan members surpassing deductibles...
An Unexpected Lesson from the Emergency Room
As actuaries, we are constantly scrutinizing unit costs, utilization patterns, reimbursements, and more in an attempt to blunt the impact of distressing healthcare...
Journey Through 30 Years of Healthcare Data Analytics
I recently hit a major career milestone of 30 years in healthcare. With my youngest daughter Kendall joining me in the office as our marketing intern...
Maximize Practice Value with Enhanced Contracting Strategies
Practices trying to improve their viability or considering or pursuing an equity transaction should look at ‘low hanging fruit’ opportunities for commercial payment increases.