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Are you ready for New York State Medicaid value-based payment models?08 November 2018 - By Brett Friedman and Rebecca L. Johnson and Howard Kahn - Article

This paper provides a high-level overview of the New York State value-based payment models, discusses the opportunities and challenges for providers considering participation in them, and highlights the needs for sophisticated actuarial, financial, and legal expertise to address the inherent business, legal, and operational risks.

Provider coding accuracy in commercial value-based contracts02 October 2017 - By Jared Hirsch and Howard Kahn and Rong Yi - Article

This paper explores various aspects of risk sharing as it pertains to value-based contracting for commercial lines of business.

Analysis of cancer care under the ACA risk adjustment methodology22 January 2016 - By Catherine M. Murphy-Barron and Howard Kahn and Rong Yi - Article

An analysis on actual claims data using stochastic simulations to model if the Patient Protection and Affordable Care Act of 2010 (ACA) risk adjustment is able to fully compensate carriers for adverse selection on cancer claims.

New insurance regulations on providers participating in alternative payment arrangements02 September 2015 - By Catherine M. Murphy-Barron and Howard Kahn and Rebecca L. Johnson and Robert Parke - Article

A recent growing trend has been to shift insurance (utilization) risk from payers to providers through alternate payment contracts (APCs) in an effort to align financial compensation with performance and financially penalize providers if certain financial and quality thresholds are not met.

Payer and provider checklist for alternative payment arrangements17 February 2015 - By Chris Dugan and Howard Kahn and Robert Parke - Article

With the adoption of nationwide healthcare reform, there are now many risk-sharing arrangements between providers and payers across all states and lines of business.

Risk adjustment for pediatric populations12 November 2013 - By Howard Kahn and Robert Parke and Rong Yi - Article

Do existing risk management methodologies capture the characteristics of pediatric-only populations?

An actuarial analysis shows that offering lung cancer screening as an insurance benefit would save lives at relatively low cost11 April 2012 - By Marcia S. Sander and Bruce S. Pyenson and Howard Kahn - Article
The results of a recent large randomized controlled trial showed that screening with low-dose spiral computed tomography reduces lung cancer mortality.Using Medicare RBRVS for reimbursing out-of-network claims in commercial insurance15 February 2012 - By Howard Kahn and Robert Parke - Article
The differences in reimbursement levels between fee schedules based on Medicare’s RBRVS and benchmark data based on prevailing charges have led to unexpected results.ACOs beyond Medicare22 April 2011 - By Victoria Boyarsky and Howard Kahn and David P. Mirkin and Robert Parke - Article
Individual providers are likely to join larger systems, many of which will find partnering with a health plan most advantageous.
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