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...
How is Your DOFR Doing?
A Division of Financial Responsibility (DOFR) is a provision in a contract between a health care provider and a health plan or payer that defines which party is financially responsible...
Should You Be Concerned About Low Rate Increases?
Health care costs are too high. What health care products or services come to mind when you read that sentence? Depending on your personal experience...
Measuring ROI For A Pediatric Care Intervention Program
Determining an ROI for any care program or intervention can be challenging, but the challenge was multiplied for a children’s hospital implementing a new care program for the sickest...
An Actuarial View of Health Care Public Policy Proposals
The number of bills which purport to expand access to public health insurance plans is now in the double-digits—and that’s just counting bills which have been introduced so far...
An Actuary Looks at 50
It’s been twenty-five years since I began my daily routine of putting on a tie (really), driving a few miles, walking across a muggy south Florida parking lot to an airport-facing building...
Health Reimbursement Arrangements: Will Employers Fund Individual Market Coverage?
On June 13th, 2019, the Departments of Health and Human Services, Labor, and Treasury issued a final rule[1] that completed the three goals of Trump’s 2017 Presidential Executive Order...