Aligning capitation rates with the line of business and risk selection of attributed members is an important component of provider contracting. Furthermore, doing so can illuminate hidden dynamics in financial...
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...
I read the 725-page draft of the Deficit Reduction Act[1] so you don’t have to. Well, I skimmed 427 pages of it while focusing on the 164 pages which make significant changes to prescription drugs. This article outlines...
“Mother-May-I” is a classic kids’ game that teaches little ones to honor their mother by having players request to take steps towards their mother but only taking steps if their mother allows it! While it would be strange...
The story of consumer value in the Affordable Care Act (ACA) individual marketplaces echoes one of the great epochs of our nation’s history where a sense of manifest destiny culminated in a quest to unite the coasts...
Health care costs continue to increase faster than the rest of the economy. Recent projections by the CMS Office of the actuary show that US health care is pushing towards a 20% share of overall GDP, an all-time record...
Over the years much has been said about the issue of increasing costs of healthcare, its causes, and solutions to address it. In terms of solutions, on one side of the spectrum is the constant drum of a government takeover...
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...
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...
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...
