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New Contract Medicare Star Ratings: Why The Sudden Cliff?
New Contract Medicare Star Ratings: Why The Sudden Cliff? On average, contracts receiving their first star rating receive ... Rating cliff? Value-based insurance design, Managed care 1/6/2020 12:00:00 AM ...- Authors: Suzanna-Grace Sayre, Danielle Beierle
- Date: Jan 2020
- Competency: External Forces & Industry Knowledge; Results-Oriented Solutions; Strategic Insight and Integration
- Publication Name: Health Watch
- Topics: Health & Disability; Health & Disability>Health care; Health & Disability>Health care quality; Health & Disability>Health insurance
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Comparing Model Error Between a Standard Risk Adjustment Model and a Disease-Specific Risk Adjustment Model
value-based care as a consequence of health care reform laws such as the Affordable Care Act (ACA) and ... value-based care as a consequence of health care reform laws such as the Affordable Care Act (ACA) and ...- Authors: Andrew Mackenzie, Ian G Duncan
- Date: Dec 2020
- Competency: External Forces & Industry Knowledge
- Publication Name: Health Watch
- Topics: Health & Disability
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Biosimilars, Part 1: A Brief Introduction
change to the pharmacy benefits status quo. As health care consultants, we have been watching the swell develop ... this primer to help educate and prepare the health care system for the coming changes and opportunities ...- Authors: Gregory Warren, Tony Pistilli
- Date: Sep 2023
- Competency: External Forces & Industry Knowledge
- Publication Name: Health Watch
- Topics: Health & Disability
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Leader Interview With Greger J. Vigen
role for CalPERS, a jumbo client that buys health care for more than a million members; and founding chair ... my core expertise of networks and provider-based care began to be used across the country, I became an ...- Authors: Greger J Vigen
- Date: Jun 2020
- Competency: External Forces & Industry Knowledge; Leadership
- Publication Name: Health Watch
- Topics: Health & Disability
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Issue Brief: Changing Financial Risks for Medigap Insurance, Part 2
(snowbirds, for example); and cover their major health care needs without MA’s utilization reviews and the risk ... as well as likely delays in receiving necessary care.[4] Providers may also appreciate Medigap-covered ...- Date: Mar 2024
- Competency: External Forces & Industry Knowledge; Strategic Insight and Integration
- Publication Name: Health Watch
- Topics: Health & Disability; Health & Disability>Health insurance; Public Policy; Public Policy
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Issue Brief: Changing Financial Risks for Medigap Insurance, Part 1
patients who deferred certain types of care or simply sought less care than they normally would (or should) ... financial improvements due to delayed and averted care in 2020 and 2021 than did other types of health ...- Authors: Kristi Bohn
- Date: Mar 2024
- Competency: External Forces & Industry Knowledge; Strategic Insight and Integration
- Publication Name: Health Watch
- Topics: Health & Disability; Health & Disability>Health insurance
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ASOP 6 and Medicare Payment Projections
facility in excess of $101.50 per day, custodial care, etc. The reimbursement decreases have led to an ... share of the expected future post-retirement health care cost for a plan partici- pant is developed by reducing ...- Authors: Charles Edwards
- Date: Aug 2003
- Competency: External Forces & Industry Knowledge
- Publication Name: Health Watch
- Topics: Health & Disability
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Health Watch, October 2020
23, 2020, the 10th anniversary of the Affordable Care Act (ACA), the Health Section Council released our ... others. • In April, we released our Value-Based Care strategic initiative. More and more we are seeing ...- Authors: Society of Actuaries
- Date: Oct 2020
- Competency: External Forces & Industry Knowledge
- Publication Name: Health Watch
- Topics: Health & Disability
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Biosimilars, Part 6: Maximizing Adoption
oncology, rheumatology, ophthalmology and diabetes care, around 90 percent or more of the prescribers surveyed ... biosimilars in rheumatology, ophthalmology and diabetes care seems to be lower. That said, 72 percent of prescribers ...- Authors: Tony Pistilli, Greg Warren
- Date: Jan 2024
- Competency: External Forces & Industry Knowledge
- Publication Name: Health Watch
- Topics: Health & Disability
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How blockchain technology will disrupt the PBM-payer-pharmacy relationship
pharmaceutical industry has many stakeholders. The primary purpose of the PBM is to serve as an intermediary ... the focus of this paper is on the private health care space. THE ORIGIN OF PBMS PBMs as we know them ...- Authors: Brian Anderson, Michael DiPrima , Greg Callahan
- Date: Apr 2020
- Competency: External Forces & Industry Knowledge; Strategic Insight and Integration
- Publication Name: Health Watch
- Topics: Health & Disability; Technology & Applications; Technology & Applications>Blockchain & cryptocurrency