Recent polls by GE and Accenture show that big data analytics is a priority for almost 90% of organizations within healthcare. Data is an essential tool for market participants that want to increase share while improving the quality of customer deliverables. And, in the not too distant future, healthcare providers and stakeholders that implement an analytics strategy will excel in clinical quality and prevention of operational bottlenecks.
In many fields, it is common to hear the terms "platform" and "application" tossed around interchangeably. The confusion is understandable because, for a non-technical person, platforms and applications can provide similar initial results. The two concepts are quite different, though, and it's important to understand which one your organization needs.
If I were going to design the worst possible health care analytics department in a health plan, TPA, or benefits consultancy, this is what I would do. First, I would go out and buy all the hardware and software licenses I needed, not to mention the database administrators and IT personnel necessary to support it. Why use the cloud? That's just a trend, right? And what about data security? The cloud can’t be nearly as secure as my data warehouse, right?
There has been so much hysteria about potential changes to the healthcare law that I feel compelled to attempt a level-headed view of things and suggest an idea. There are a lot of moving parts here, but I am going to stick to the pre-existing conditions portion as that one seems to get the most angst or at least the most television news coverage. The acronyms for the ACA and the ACHA are so close, let me simply call them Obamacare and Trumpcare for clarity. I heard Warren Buffett the[...]
I was listening to the news on the radio and heard a commercial from the AARP about proposed repeal and replace changes in the American Health Care Act that will allow health insurers to charge older Americans up to 5 times more than younger Americans for health insurance. The bill is referred to as the State Age Rating Flexibility Act of 2017. In the words of the AARP, this is an unfair age tax. I do not want to misrepresent the position of the AARP, an organization that helps millions[...]
I’ve spent my entire professional career in healthcare - 24 years and counting. The vast majority of that time was spent in the cost containment segment, in particular PPO network management strategies and out-of-network repricing and negotiation strategies. For years, I passionately believed that the products and services I represented were providing value to my clients by reducing their paid claims expense. Over the last 5-7 years of my tenure in that segment of the business it became more[...]
I can still remember being little, losing a tooth and being amazed that a quarter (showing my age) found its' way under my pillow by the time I woke up. Of course, it is only something we believe for a few years before we realize mom or dad funded the quarter. Even reaching that realization and loss of innocence provides great value in that we learned that every benefit had to be funded somehow.
What is the price of offering insurance to folks with pre-existing conditions on the health exchanges and how do we solve the problem without putting in the mandatory insurance requirements under the Affordable Care Act regulations?To understand this you first need to understand that health insurance is simply a reflection of the claims cost plus administration and profit. Next you need to understand the distribution of medical expenses, which can fluctuate with populations, co-pays,[...]
Due to our presence in the Population Health Analytics space, I often get asked about what we should do about the Affordable Care Act ("ACA") and the declining choices at greatly escalating rates. As ACA open enrollment starts this week, I've been thinking a lot about this question, and I think it's timely to consider some solutions today. I look at a lot of data, so a couple of simple observations first. Health insurance isn't that complicated. Add up total claims on a population and[...]
Reference Based Pricing Lately, all eyes are on Reference Based Pricing (RBP). In fact, it was standing room only at the Reference Based Reimbursement (RBR) discussion panel last month in Austin at SIIA's biggest event of the year. SIIA’s National Educational Conference & Expo is the world’s largest event dedicated exclusively to the self-insurance/alternative risk transfer industry. RBP was also a hot topic at the recent SPBA conference in Minneapolis, and it’s clear that many TPA’s are[...]