Healthcare costs

By Christopher S. Girod, Susan K. Hart, Scott A. Weltz  |  21 May 2018

Healthcare costs for the typical American family of four rose to over $28,000 in 2018.

By Lindsy Kotecki  |  11 April 2018

Healthcare provider organizations can benefit in many ways from adopting actuarial approaches, which can help them improve financial security, strengthen leverage in negotiations, and advance clinical capabilities.

By Ksenia Whittal, Ally Weaver  |  22 March 2018

This paper explores relationships between lifestyle factors and morbidity that the authors encountered in their experience working with consumer and administrative claims data.

By Ksenia Whittal  |  22 March 2018

This analysis examines predictive models to determine if an enhanced model can better identify individuals with rising risk relative to traditional prospective risk adjustment models.

By Stoddard Davenport, Katie Matthews  |  09 March 2018

Over 25 million American adults report suffering from daily chronic pain. The increasing use of opioids in recent years has taken a human toll, leading to a rising number of overdose deaths and diagnoses of opioid use disorder.

By Laurie Lingefelt  |  06 March 2018

As the use of value-based reimbursement programs and the associated financial impact increases, it is important for providers to be educated on the mechanics of the program and to understand the analytical, operational, and clinical requirements to ensure success.

By Joanne Buckle  |  02 March 2018

There is still some uncertainty regarding the future uptake of genomic testing and the levels of sophistication of new tests, and this article discusses some relevant considerations that can support a greater appreciation of the risks and gains to payers involved in funding these tests now.

By Lalit Baveja, Tanya Hayward  |  23 February 2018

This article discusses a clinic-based community intervention designed to improve access and quality of care for high-utilising, high-risk patients over the course of three years.

By David Stoddard  |  13 February 2018

Trustees and administrators should keep a number of topics in mind when planning for 2018 and beyond.

By Stephen P. Melek, Doug Norris, Jordan Paulus, Katie Matthews, Ally Weaver, Stoddard Davenport  |  12 February 2018

This report uses healthcare cost and utilization data to project spending estimates for people with chronic medical and comorbid behavioral conditions in 2017.

02 February 2018

Amazon, Berkshire Hathaway, and JPMorgan Chase bring a fascinating variety of perspectives to the challenges of healthcare.

By Joanne Buckle, Tanya Hayward  |  15 January 2018

This paper presents a case study to discuss the process and considerations for developing an accountable care system in a regional National Health Service system.

By Lalit Baveja, Mason Roberts  |  10 January 2018

The literature shows that a disease management programme is not a guarantee of cost savings, but in addition to community health improvements and improved clinical outcomes, desired cost savings can be realised if the programme is designed correctly.

By Stephanie Peterson, Shyam Kolli, Marcella Giorgou, Elaine Britt  |  10 January 2018

Health and group benefits news and developments in the United States.

By Pamela M. Pelizzari, Jocelyn Lau, Harsha Mirchandani  |  08 January 2018

This paper combines data from the report of Performance Year 1 (PY1) results and other publically available sources to compare hospitals that received payments in the Comprehensive Care for Joint Replacement model PY1 to those that did not.

By Victoria Boyarsky, Rong Yi  |  05 January 2018

This paper focuses on three proposed changes in the Notice of Benefit and Payment Parameters for 2019 that would likely affect premiums in the individual and small group markets.

By Christopher Kunkel, Lynn F. Dong, Nicholas Johnson, Adam Barnhart  |  04 January 2018

A discussion of some of the most important considerations for Medicare Advantage risk-sharing arrangements that include Part D coverage.

28 December 2017

Facts relating to global health can be elusive. Even when they are known, they are rarely put to use in improving health outcomes. So what can be done to fix the problem?

By Maggie Alston, Christine Ferro, L. Daniel Muldoon, Pamela M. Pelizzari  |  11 December 2017

This paper highlights the key aspects of alternative payment model payment methodologies and uses the Centers for Medicare and Medicaid Services Oncology Care Model as a case study to illustrate these concepts.

By Stephen P. Melek, Daniel J. Perlman, Stoddard Davenport, Katie Matthews, Michael Mager  |  22 November 2017

What has happened to utilization and costs for mental health and substance use disorder benefits as the mental health parity laws and associated rules were slowly rolled out?