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Durham, Connecticut, United States
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Starting off my work week with this lovely human, one of my favorite people, Melissa Reilly. This is also her first week of #preferement (as Melissa…
Starting off my work week with this lovely human, one of my favorite people, Melissa Reilly. This is also her first week of #preferement (as Melissa…
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I'm excited to finally share what I've been working on post-Casper! We’re excited to announce that we’re creating the first AI mental health…
I'm excited to finally share what I've been working on post-Casper! We’re excited to announce that we’re creating the first AI mental health…
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Francois de Brantes
Good primer on the rise of self-insurance, but also why it is essential for employers and their brokers or benefits consultants to use a new, less conflicted lens in assessing employer options for plan administration. The bottom line for self-insured employers, as Chris Deacon and Jeffrey Hogan repeatedly remind them, you're the fiduciary and if you ignore your fiduciary obligations, you are in legal jeopardy.
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Below the Line Club
Today's webinar by Study Groups and Below the Line Club featured Ty Franklin, Senior Consultant and Actuary at Alera Group, Inc., who talked about the current state of American health insurance and how to take control of your healthcare spend. #healthinsurance #employeebenefits https://lnkd.in/gMycBkrV
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Keaton Bedell
Excellent piece from Christina Farr examining the explosion of point solutions purchased by employers since COVID and the associated fatigue and backlash. Employers need to get out of the health insurance and care delivery game and focus on their core business. Vetting, managing, and measuring the impact of 20+ point solutions is not their area of expertise. This looks like: 1. Move from self-insured to defined contribution (ICHRA) 2. Access care through in-network providers (with Bridge) 3. If an employer stays self insured, push point solutions to bill via claims rails so impact is more easily measurable. (Something we are exploring)
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Clarify Health Solutions
Leveraging healthcare claims data is one way health plan leaders can reduce costs, grow their networks, and enhance outcomes for their members. But what are the strategies for success? We focus on these opportunities in our new three-part series, "Unlocking the Potential of Healthcare Claims Data." https://ow.ly/f82Q50S15Xl #claimsdata #payers #betteroutcomes
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Richard Navarro
Brad Paulis, ASA, MAAA, and Partner at Continuing Care Actuaries will be participating in the LeadingAge / Ziegler CCRC CFO Conference Brad’s session will be on Thursday, April 25 at 11:00 AM CT HCBS Pivot – A Closer Look into Continuing Care at Home This year’s HCBS discussion will pivot to the topic of Continuing Care at Home (CCaH). As organizations look to diversify revenues and service lines, expanding the continuum into people’s homes will take a fresh look in this year’s session. Objectives: 1. Overview of services that are provided for Continuing Care at Home and payor arrangements for CCaH 2. Overview of trends related to this emerging area of care 3. Deep dive into case studies exploring the “Look of CCaH”
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First Health Advisory
Drex DeFord Advises Simplifying Healthcare for Vendor Risk Reduction: https://lnkd.in/dDvhYsDF First Health Strategic Advisory Board Member & Healthcare Strategist Drex DeFord dives into pressing concerns around the increasingly complex, difficult to manage, and frequently targeted healthcare environment. Drex’s conversations with This Week Health fuel meaningful conversations to spur the change necessary for improving health sector resilience. We’re proud to have such a dedicated member of the healthcare cybersecurity space advising our leaders and ensuring First Health is at the forefront of digital health security innovation. For more insight into First Health’s leadership and board members, visit https://lnkd.in/gQUx5BzD or contact First Health at info@firsthealthadvisory.com. #CISO #CIO #CTO #CDO #Compliance #HIPAA #HealthcareIT #HealthcareSecurity #CyberRisk #ThirdPartyRisk #RiskAssessment #Cybersecurity #HTM #DigitalHealth #PatientSafety
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Papa
It’s crucial for supplemental benefits today to demonstrate clear value for both members and their health plan partners. This is a concept we understand well at Papa, having created and scaled a category-defining model—and we continually invest in research to further validate and inform our approach. Like our latest claims analysis that showed Medicare Advantage members who engaged in at least one #Papa visit were associated with a 9% reduction in medical costs. And the impact doesn’t stop there. 🚀 Members who engaged in more Papa visits saw even greater cost reductions, showing the potentially exponential impact long-term connection can have on an individual’s health, including: • 19% reduction in medical costs for members who average more than two Papa visits per month • 30% reduction in medical costs for members who average more than three Papa visits per month 📈 As plans look to enhance their offerings following the recent #CMS Star Rating recalculations, further investing in companion care is proven to maximize impact for your members. Learn how Papa can reduce healthcare costs and improve outcomes for your plan: https://lnkd.in/ejMf_But
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Rate-Fast
Are we stuck in the past with workers' compensation assessments? 🤔 In our latest podcast, Dr. John Alchemy, MD, AAFP, QME of Rate-Fast challenges the status quo, introducing the game-changing Functional Loss Rating (FLR) method. 🎯 Key takeaways: • Why traditional methods like Four Corners Rating fall short • How FLR's precision captures true injury impact • The potential for faster benefit distribution and claim settlements Is it time for a revolution in workers' comp? Listen now to find out how FLR could transform your approach to impairment ratings. Discover more information on this topic in our blog: Understanding Confidence in the FLR (Functional Loss Rating) Method – RateFast Blog (https://lnkd.in/gbcP4mT2) #WorkersCompensation #Innovation #MedicalAssessment #RateFast
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Mark Head
Although "interoperability" may seem esoteric, and certainly not top of mind for the typical employee, employer HR/Benefit, and consultant teams - it's critical for improving the patient (and thus, employee) experience, as well as for providing the closer-to-real-time access necessary to support sophisticated clinical management initiatives. Thanks for posting, Frank! #healthmanagement #dataanalytics #employeeexperience #patientexperience #hrstrategy
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Lower outpatient costs. Lower emergency room costs. Lower out-of-network spend. Is that something you’re interested in? Because at Personify Health, we are. And we can make it happen. We just unveiled the findings of a new independent actuarial study from Wakely Consulting Group demonstrating that key company programs drove significantly lower healthcare costs for members - including 23% lower allowed costs vs. market average, and 14% lower costs for high-cost claimants. With health costs continuing to skyrocket this year, addressing both costs and outcomes have become business imperatives. Our CEO Chris Michalak noted, “…the Wakely analysis proves that our care management and cost containment programs are highly effective across a range of areas responsible for the biggest spend. Combining hundreds of experts with the scalability driven by AI, we’re solving a big industry challenge and making a real difference for our clients and members – without compromise.” Read more here: https://bit.ly/4cGEoBL #employeehealth #healthcosts #becausehealthispersonal
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Despite the potential for severe damage, only 22% of homeowners surveyed by Munich Re US and the Insurance Information Institute (Triple-I) believe they are at risk of flooding. Check out the latest Insurance Business America article hear from Tim Brockett about the critical gap between perceived and actual flood risk among US homeowners: https://ow.ly/g6gb50SqqtC #MunichReUS #FloodRisk
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Chuck Wacker
By tapping into the power of data to identify high-risk members, brokers and their clients are able to better manage their healthcare benefits. Read #MultiPlan's latest #BenInsights case study and see how our solution helped an employer identify members that were at the highest risk for costly Musculoskeletal disorders. Check it out 👇 https://ow.ly/Nohn50Szwoa #EmployerBenefits #HealthcareBrokers
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Hello Heart
As #GLP1s show promise for cardiovascular health, employers and insurers are navigating how to improve #CVD outcomes without blowing up their benefits budget. On the latest Friends with Your Benefits podcast, John Coleman, CEBS and Hello Heart's VP, Health Strategy Jenn Roberts explore strategies companies are using to protect hearts *and* budgets. ❤️ 💰 Watch here: https://lnkd.in/erUgvRXz #EmployeeBenefits
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ECHO, Payments Simplified®
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Trey R.
Payers are increasingly turning to advanced actuarial models to enhance their decision-making processes and optimize patient outcomes. By integrating consumer data into these models, we're not just predicting costs; we're reshaping how healthcare is delivered and financed. Here are some key use cases where advanced actuarial modeling stands out: 1. **Personalized Premium Setting**: Leveraging consumer behavior data allows for more accurate and individualized premium calculations. By analyzing lifestyle choices, purchasing behaviors, and wellness activities, payers can tailor premiums that reflect the true risk and potential healthcare costs of individuals. 2. **Enhanced Risk Assessment**: Consumer data provides deeper insights into the social determinants of health, offering a broader perspective on risk factors. Actuarial models that incorporate this data can better predict high-cost events, leading to more effective risk management strategies. 3. **Targeted Health Interventions**: With a richer dataset, models can identify at-risk populations and guide the deployment of targeted intervention programs. This proactive approach not only improves patient health but also reduces unnecessary expenditures by preventing adverse health events before they occur. 4. **Improved Member Engagement**: Understanding consumer preferences and behaviors helps payers design more engaging and effective communication strategies. This results in higher member satisfaction and retention rates, as interventions and communications are more likely to resonate and encourage positive health behaviors. 5. **Fraud Detection and Prevention**: Advanced modeling techniques can detect anomalies in claims data that may indicate fraudulent activities. By integrating consumer data, these models become more adept at spotting irregular patterns, safeguarding against losses and ensuring financial stability. The integration of consumer data into actuarial models is not without challenges, particularly around data privacy and security. However, with robust data governance frameworks, we can harness the full potential of this data while upholding the highest standards of consumer protection. Let's connect and discuss how we can further advance the role of actuarial science in healthcare. The future is data-driven, and together, we can lead the way. #ActuarialScience #HealthcareData #DataAnalytics #HealthcareInnovation #ConsumerData
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Providence Health Plan
Last week, leaders from the health insurance industry met in Las Vegas to discuss the most significant topics facing payers today, including value-based care. In one conversation, Providence Health Plan's President and CEO Don Antonucci called out the need for payers and providers to embrace the shift toward value-based care in the industry, especially as more of the financial burden from the traditional Medicare system is pushed onto employers. You can read Don's insights at https://lnkd.in/gRDK_5if
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