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...
Maximize Practice Value with Enhanced Contracting Strategies
Practices trying to improve their viability or considering or pursuing an equity transaction should look at ‘low hanging fruit’ opportunities for commercial payment increases.
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...
Understanding Provider Financial Losses in Value-Based Contracts
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...
What is the “Value” in Value-Based Care?
In the ever-evolving landscape of healthcare, the terms "value-based reimbursement" and "value-based care" (VBC) have become buzzwords that signify a shift in how we approach...
Plan Design Considerations for Self-Funded Employers
Unlike insurers whose plans must comply with strict metal tier and essential health benefit requirements, self-funded groups benefit from flexibility of plan design and offerings. However...
Paying the Piper: How 2020 Could Make 2023 Even Tougher for Value-Based Care Providers
It’s widely predicted that 2023 will pose broad economic challenges. Reasons abound for a potential recession, but in many ways, it’s time to pay the piper for actions taken during COVID. That’s not to suggest no fiscal...
Plan Design Survey of the 2023 Individual Market
The macroeconomic environment is radically shifting as inflation ratchets up costs in every consumer category, including health care. AHP has already written extensively on broader inflation’s impact on trend, painting...
Intelligent Capitation Rates – Strategically Aligning Risk Adjustment with Costs
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...
Utilization Profiling for Care Management (and Profitability!)
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...