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...
Actuaries to the Rescue: Recovery from Bankruptcy
Bankruptcies are on the rise for healthcare companies backed by private equity and venture capital[1]. A recent study discovered that PE-backed bankruptcies in 2023 were more than double compared...
Measuring Health Care Innovator Value
The US healthcare system is known for its high costs compared to other developed countries. Several factors contribute to this, including administrative expenses, pharmaceutical prices, and the...
The Importance of IBNR in Self-Funded and Traditional Health Plans
Understanding and accurately predicting future liabilities is crucial to the sustainability and success of insurance companies and self-insured employer-sponsored health plans...
Inflation Reduction Act Pharmacy Provisions – Implications and Other Changes
This is the final article in a three-part series[1],[2] discussing the impact of the Inflation Reduction Act (IRA; H.R. 5376)[3] provisions. First, we’ll cover the Medicare...
Inflation Reduction Act Pharmacy Provisions – Part D Changes
This is the second[1] in a three-part series discussing the impact of the Inflation Reduction Act (IRA; H.R. 5376)[2]provisions. Here we’ll look deeper into the changes coming to Medicare...
Diagnosis Co-Occurrence
Patients with multiple chronic diseases constitute a small minority of the total population but the majority of healthcare costs. These patient’s healthcare needs cannot be understood...