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...
A Provider’s Primer for Shared Savings Arrangements
Shared savings arrangements have increased in popularity as healthcare shifts towards value-based care. In its most basic form, the total healthcare costs of members associated (i.e., or those attributed)...
Geographic Utilization Disparities and Financial Impacts
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...
An Actuarial Guide to Medicare Direct Contracting
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...
California Health Plan Market Summary
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...