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.
As actuaries, we are constantly scrutinizing unit costs, utilization patterns, reimbursements, and more in an attempt to blunt the impact of distressing healthcare...
The shift from fee-for-service (FFS) healthcare models to value-based care (VBC) has been a monumental transformation in the healthcare industry. However, as this transition unfolds, it has added significant complexity to the healthcare system...
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...
It seems natural to assume that the scientific underpinning of medicine implies a formulaic treatment for any given combination of presenting symptoms. However, this assertion ignores the artistic nature of care management...
For the better part of the last few years, terms in the healthcare space like “Medicare for All”, “preexisting conditions”, and “if you like your doctor you can keep them” have been...
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...
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...
In many of our recent client situations we encounter a surprising lack of awareness and concern about the [...]
