Health care is expensive in the United States. If you have paid attention to the Society of Actuaries Health Section since 2018, you are familiar with Initiative 18/11. The catchy title derives from the fact that health care spending is...
On April 1, 2021, the Global and Professional Direct Contracting (GPDC) Model began its first performance year. Effective through 2026, the CMS GPDC Model introduces risk sharing arrangements with the goal of reducing...
One of the most underappreciated cornerstones of the Affordable Care Act (ACA) is that premium variation...
In California, the DMHC and DOI facilitate a transparent and accessible means to look up rates and rating information for plans in the individual and small group market. However, gathering a market-encompassing view of the...
Our firm recently hired its first data scientist to complement the consulting team of health actuaries and clinicians. The Actuarial profession is very small and niche, with many people outside of the insurance and pension industries...
Nine months ago, we gathered in our conference room to talk about COVID-19 and what it may look like in the coming months. When you put a bunch of data geeks with healthcare expertise in a room the opinions were diverse...
What if I told you that two sentences in a rate filing guidance could potentially add $5 billion of federal subsidies to the individual market and bring substantial premium relief...
The Affordable Care Act (ACA) provides states with multiple opportunities to improve their local markets. Most options involve a significant investment, both staff time and financial resources. Earlier this year...
While health insurers and health plans have historically assumed most of the risk associated with managing the healthcare dollar, recent trends towards capitation and bundled payments show providers having an increased appetite...
Last year I developed a ranking system for analyzing consumer value in ACA markets across all 50 states[1]. It was a fun and enlightening exercise. Please see the link below for last year’s rankings which will include the details of...
