Being Actuarial, Actuarially Sound, Or Just Plain Faking It…
Being an actuary has been a very enjoyable career for the last 16 years. I have worked on many different projects from the smallest review of data to multi-billion-dollar litigations...
The Gold Rush and the Lionfish: Optimizing the Unique Dynamics in ACA Markets
The Affordable Care Act (ACA), colloquially known as “Obamacare”, recently began its 7thopen enrollment period, the first with premiums based on claims experience after...
What Is The “Total Cost Of Care” And Why Does It Matter?
If you work in the healthcare space, you often hear the term “Total Cost of Care”. The more you hear the term the more you may wonder what it means and why it is important...
Transforms: a la Health Care Style
Students of mathematics are familiar with the concepts of transforms or transformations (e.g., LaPlace or Fourier transforms). Essentially these are tools which help mathematicians...
Question: Should We Do This or Not? Answer: We Need an Assessment of Value!
Sometimes the hardest business questions have the simplest of answers. This is also true for the many nagging questions we encounter in healthcare. Too often the decision making process...
Physician Fee Schedules: How Do They Compare and What’s Next?
When you visit your doctor, you will typically be charged a small copay, coinsurance amount, or may not even have to make a payment at all. This is done because you know that your...
Defining a Bundled Payment Rate for Bone Marrow Transplants
Insurers and providers are increasingly pushing for bundled payments and other forms of value-based reimbursement in their contracts with health systems. The ideal candidate...
The Cost of Consolidation
Consolidation is aggressively moving through much of the US economy. Everything from coffee shops to airlines are consolidating and the effect on the consumer is varied...
Closing the Loop on Value Based Reimbursement and Incentive Programs
The phrase “closing the loop” is often used when traditional communication approaches have failed or have been ineffective. In a recent article[1], a writer said...
Developing Financial Projections for Start-Up Health Plans
Throughout the United States, new health plans are emerging as provider systems and nontraditional organizations seek to enter the market. Licensure of these health plans happens...