Deerwalk Blog

Medicare Reference Pricing - A Prescription to Fix the ACA

Posted by Jeff Gasser on November 01, 2016

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[...]

Deerwalk & ClearHealth - Like Surf & Turf for Medicare Reference Pricing

Posted by Maris Mejia on October 27, 2016

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[...]

Finally....Medicare Reference Pricing embedded in my Population Health Analytics application!

Posted by Tim Huke on August 04, 2016

The more time I spent in the field this past spring, the more I heard from both existing and potential clients about the need to analyze plan allowed amounts against Medicare pricing equivalencies.  It's no secret that employers, brokers, consultants, TPA's and health plans are all considering various reference-based or Medicare-based pricing strategies in their plan designs.  Whether considering a total PPO replacement, a narrow network strategy complemented with Medicare pricing wrapped[...]

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