Risk Adjusted Episodes as Benchmarks for ACOs: A Society of Actuaries Sponsored Study
|
|
|
- Kathlyn Barbara Potter
- 5 years ago
- Views:
Transcription
1 Risk Adjusted Episodes as Benchmarks for ACOs: A Society of Actuaries Sponsored Study Presented by Bill O Brien, FSA, MAAA Consulting Actuary Milliman Houston, TX (832) Preconference I
2 Agenda Quick Overview - What s Driving ACOs? Strategy, Strategy, Strategy Physician Group Practices Hospital Systems Preserving FFS Revenues alongside ACOs Which way will the balance tip? SOA Research Project on Accountable Care Organizations 2 October 26, 2012
3 What s driving ACOs? Accountable Care Act CMS Shared Savings Program (MSSP) CMMI Pioneer ACO Pursued mainly by physician group practices Overall shift from FFS to Value/Population-based payments that include adjustments for Quality Outcomes Bundled Payments Gain Sharing Arrangements Capitations 3 October 26, 2012
4 Differing Incentives: Hospitals vs. Physicians One Party s Savings = Another s lost Revenue Physicians Physicians primary driver of savings from hospitals Little lost revenue until near well managed New Revenue Stream opportunity Hospital savings Can be used to finance practice improvements in efficiency CMS offering partial up-front payments for small, rural practices Vast Majority of MSSPs are physician organizations Options that offer upside risk only 4 October 26, 2012
5 Differing Incentives: Hospitals vs. Physicians Hospitals One Party s Savings = Another s lost Revenue Most early Savings come from reduced hospital margins Creates conflicting incentives for FFS vs. Population-based Consensus Change is happening now and accelerating into 2014 Hospitals would need >75% of savings to replace lost margin contributions from eliminated services There is no status quo option FFS may soon be a casualty of high costs, reform Dangers: Moving too quickly before fixed costs are reduced Moving too slowly and being shut out of ACO networks, payers Physicians create an ACO and cut out the hospital 5 October 26, 2012
6 Differing Incentives: Hospitals vs. Physicians Hospital Responses Buying strategic physician practices Primary Care, Hospital-based physicians Medicare Reimbursement opportunities (e.g. Oncology) Partnering/Merging with other hospital systems Everyone is talking to Everyone Bundled Services or Capitations Controlling the revenue Requires discounting current and future services Starting an HMO Insert themselves higher in the revenue stream HMO margins offset some lost Hospital margins 6 October 26, 2012
7 Initial Population Targets Hospital system employee health plan Generally self funded; Savings (mostly) accrue to system Medicare Advantage Product simplicity Large portion of patient populations High potential for savings Medicaid Managed Care Savings offset low unit reimbursements Commercial & ASO/TPA Revenue to cover administrative costs of other products Preparation for exchanges 7 October 26, 2012
8 Balancing Act FFS payments still dominant Optimistically, may be 50% at-risk in 2-3 years Some services, specialties don t bundle easily Many providers not pursuing risk strategies preserve FFS Spillover Effect Improved Efficiency = Services eliminated = Poor FFS performance Physician Compensation Must promote/reward conflicting goals Reduced costs per episode of care Increased quality and outcome measures Increased patient services volume (FFS) 8 October 26, 2012
9 SOA Research Launched April, 2012 Multiple Milliman offices participating Goal: To develop tools and methods to help ACOs achieve and measure financial success Take episode of care analytics to next level Risk adjusted costs and utilization by service type Scheduled Publication in late October 26, 2012
10 SOA Research Approach: Risk adjust Episode of Care cost and utilization experience High-cost or avoidable service utilization Total costs by major service type (IP, OP, Pharma, Physic) Develop a financial model to estimate potential savings within Episode types, as ACO care efficiency improves; Reflect variation due to population size Develop methods for evaluating ACO results based on annual claims data. 10 October 26, 2012
11 ACO Episode Risk-Adjustment Study Entire 3 Million Population Aggregate Costs by Episode Type DRAFT Episode Type: Episodes per Thousand Member per Year Normalized Allowed Cost per Episode PMPM Asthma 41.0 $ 1,104.0 $ 3.52 Cerebral Vascular Disease 3.0 $ 8,059.0 $ 1.88 Chronic Obstructive Pulmonary Disease 6.0 $ 2,384.0 $ 1.11 Congestive Heart Failure 2.0 $ 6,103.0 $ 0.95 Diabetes 40.0 $ 2,391.0 $ 7.44 Hyperlipidemia 68.0 $ $ 2.92 Hypertension $ $ 7.27 Ischemic Heart Disease 13.0 $ 8,742.0 $ 8.84 Joint Degeneration, localized - back 33.0 $ 3,715.0 $ 9.54 Pregnancy with Delivery 13.0 $ 12,798.0 $ Risk Adjusted Episodes $ 2,191.1 $ October 26, 2012
12 SOA Research Utilization Metrics for Risk Adjustment Medical/Surgical Hospital inpatient admissions Avoidable Emergency Room Visits Advance Imaging Services (CT, MRI, PET Scans) Physician Office Visits (Primary & Specialty) 12 October 26, 2012
13 SOA Research Cost per Episode Metrics for Risk Adjustment Total All Services Inpatient Costs Outpatient Costs Physician/Other Costs Pharmacy Costs 13 October 26, 2012
14 Episode: Ischemic Heart Disease Service Type Utilization per Thousand Episodes Normalized Allowed Cost per Unit within Episode Cost Per Episode Raw Units Risk Adj Days/Unit Days Unit per Day Raw Risk Adj Inpatient Med/Surg Admissions XX XX X X $X $X X Other Inpatient X X X $X $X X Total Inpatient X X X $X $X $XX $XX Outpatient Avoidable ER Visits XX XX $XX $XX Advanced Imaging XX XX $XX $XX ER - Urgent X X X OP Surgery X X X Radiology - General X X X Pathology X X X Therapies X X X Other Outpatient X Total Outpatient $XX $XX Professional/Other Office Visits XX XX X X ER Visits X X X Consults X X X Inpatient Surgery X X X Outpatient Surgery X X X Inpatient Visits X X X Preventive Services X X X Pathology X X X Radiology X X X Physical Therapy X X X Cardiovascular X X X Durable Medical Equip X X X Home Health X X X Other Pro/Other X Total Pro/Other $XX $XX Pharmacy Branded Drugs X X X X X X Non-Branded Drugs X X X X X X Total Pharmacy X X X X X $XX $XX Total Total All Services $XX $XX 14 October 26, 2012
15 Episode: Ischemic Heart Disease Population Full Market Scan Sample Service Type Measure Unit Mean Percentiles Raw/ Risk Adjusted 25th 50th 75th 90th 95th 99th Inpatient Med/Surg Admissions per Thousand Episodes Total Inpatient Costs Cost per Episode Outpatient Avoidable ER Visits per Thousand Episodes Advanced Imaging Total Outpatient per Thousand Episodes Cost per Episode Professional/Other Office Visits per Thousand Episodes Total Pro/Other Cost per Episode Pharmacy Branded Drugs Percentage Non-Branded Drugs Total Pharmacy Percentage Cost per Episode Total Total All Services Cost per Episode 15 October 26, 2012
16 QUESTIONS AND DISCUSSION 16 October 26, 2012
ACO Benchmarks and Financial Success SOA Sponsored Research
ACO Benchmarks and Financial Success SOA Sponsored Research Presented by: Rong Yi, PhD Milliman, New York City 6 th National Predictive Modeling Summit December 6, 2012 DISCLAIMER The research project
Population Health and Wellness: 2 Stories from Cleveland Clinic. Elizabeth Sump Senior Director, Health Policy Cleveland Clinic
Population Health and Wellness: 2 Stories from Cleveland Clinic Elizabeth Sump Senior Director, Health Policy Cleveland Clinic 1 2 population health stories Cleveland Clinic Employee Health Plan Cleveland
Controlling Healthcare Costs through Innovative Methods - Analytics
Controlling Healthcare Costs through Innovative Methods - Analytics 2 What are we seeing? Trend is improving, but still significantly above general inflation 10% 8% 6% 9.0% 9.0% 8.5% 7.5% 6.5% 6.8% 6.2%
Using Analytics To Transform Your ACO
Using Analytics To Transform Your ACO How to Develop Effective Cost Reduction Strategies Presented July 2016 Agenda and Presenter External Forces and Market Response Critical Success Factors Analytics
Provisions of the Medicare Modernization Act
Provisions of the Medicare Modernization Act Medicare Prescription Drug Modernization and Improvement Act of 2003 (MMA) Todd Whitney, FSA, MAAA Wakely Consulting Group Highlights of New Act New Rx Benefit
2018 NMRHCA Benefits Presentation Presbyterian Senior Care (HMO-POS) Plan I and Plan II
2018 NMRHCA Benefits Presentation Presbyterian Senior Care (HMO-POS) Plan I and Plan II Who we are Started in 1908 as a Tuberculosis Sanatorium Presbyterian Today Locally owned, nonprofit healthcare system
2018 MEDICARE. summary of benefits. advantage plan. Serving Members in Josephine & Jackson Counties
2018 MEDICARE advantage plan summary of benefits Serving Members in Josephine & Jackson Counties Table of Contents About the Summary of Benefits... 1 Who Can Join?... 1 Which doctors, hospitals and pharmacies
DELIVERING HIGHER-VALUE MATERNITY CARE
DELIVERING HIGHER-VALUE MATERNITY CARE Designing Alternative Payment Models for Better Care, Lower Spending, and Financially Viable Maternity Care Providers Harold D. Miller President and CEO Center for
Annual Notice of Changes for 2016
True Blue Rx Option I (HMO-POS) offered by Blue Cross of Idaho Care Plus, Inc. Annual Notice of Changes for 2016 You are currently enrolled as a member of True Blue RX Option I (HMO-POS). Next year, there
and cardiac diagnostic procedures utilizing nuclear medicine) Bariatric surgery Not Covered Not Covered
An independent member of the Blue Shield Association Wesco Aircraft ASO PPO Benefit Summary (For groups of 300 and above) (Uniform Health Plan Benefits and Coverage Matrix) Blue Shield of California Effective:
2017 NMRHCA Benefits Presentation
2017 NMRHCA Benefits Presentation Presbyterian Senior Care (HMO-POS) Plan I and Plan II _[code]_[mmddyyyy] Who we are Started in 1908 as a Tuberculosis Sanatorium Presbyterian Today Locally owned, nonprofit
How Bundled Payments Create Value in New Product Designs Cognizant
How Bundled Payments Create Value in New Product Designs 1 About Cognizant 2 This Will Not Take Long. 3 What is a Health Insurance Product? 4 Understanding Product Design Commercial Insurance One specific
Presentation by Kevin Stone Senior Consultant and Principal Helms & Company Concord NH
Presentation by Kevin Stone Senior Consultant and Principal Helms & Company Concord NH Medicaid is Largest Payer- covers 1/3 of entire population Vt. funded Medicaid Expansion program pre- ACA (VHAP; Catamount)
Health Benefits Simplified. CopperSands Inc. Medical Benefits Overview. Effective 10/1/
Health Benefits Simplified CopperSands Inc. Medical Benefits Overview Welcome! HealthEZ is a national benefit administrator that specializes in helping companies like CopperSands Inc. provide affordable,
A Path to Accountable Care Organizations: How Do We Get From There to Here? Financial Considerations for Accountable
A Path to Accountable Care Organizations: How Do We Get From There to Here? Financial Considerations for Accountable Care Entity Engagement Presented by Milliman, Inc. San Francisco, CA susan.pantely@milliman.com
Medical Plan Summary: PPO Core Plan
Medical Plan Summary: PPO Core Plan Healthcare is one of the most important and necessary parts of your benefit package. The following is a summary of our benefit plan. For a more detailed explanation
West Suburban Health Group High Deductible Health Plan with HSA
West Suburban Health Group High Deductible Health Plan with HSA November 30, 2017 Today s Agenda 1. Consumer Driven Health A new way to Receive Your Health Benefits 2. HMO/PPO Plan Design Features 3. Health
FUNDS FLOW METHODOLOGY FOR RISK-BASED CONTRACTS
CENTER FOR INDUSTRY TRANSFORMATION MAY 2015 FUNDS FLOW METHODOLOGY FOR RISK-BASED CONTRACTS Authors Amy Bibby Partner, DHG Healthcare amy.bibby@dhgllp.com Matthew Fadel Manager, DHG Healthcare matt.fadel@dhgllp.com
2019 Benefits Open Enrollment. High Deductible Health Plan (HDHP) with Health Savings Account (HSA) Deep Dive LEWIS & CLARK COLLEGE
2019 Benefits Open Enrollment High Deductible Health Plan (HDHP) with Health Savings Account (HSA) Deep Dive LEWIS & CLARK COLLEGE AGENDA What is a High Deductible Health Plan (HDHP) with Health Savings
MID-YEAR QUALITY AND RESOURCE USE REPORT
MID-YEAR QUALITY AND RESOURCE USE REPORT SOUTHEAST TEXAS MEDICAL ASSOCIATES LLP Last Four Digits of Your Medicare Taxpayer Identification Number (TIN): 7095 PERFORMANCE PERIOD: 07/01/2014-06/30/2015 ABOUT
Session 66 L, Value Based Approach for the Medicare Advantage Market. Presenters: Julia Friedman, FSA, MAAA Matthew Kranovich, FSA, MAAA
Session 66 L, Value Based Approach for the Medicare Advantage Market Presenters: Julia Friedman, FSA, MAAA Matthew Kranovich, FSA, MAAA SOA Antitrust Disclaimer SOA Presentation Disclaimer Value Based
Milliman RBRVS for Hospitals
Will Fox, FSA, MAAA Ed Jhu, FSA, MAAA Charlie Mills, FSA, MAAA WHAT IS RBRVS FOR HOSPITALS? The Fee Schedule provides a simple solution for comparing hospital contractual allowed amounts, billed charge
Full PPO Combined Deductible /60 Benefit Summary (For groups of 101 and above) (Uniform Health Plan Benefits and Coverage Matrix)
An independent member of the Blue Shield Association Full PPO Combined Deductible 25-250 90/60 Benefit Summary (For groups of 101 and above) (Uniform Health Plan Benefits and Coverage Matrix) Blue Shield
Building Actuarial Cost Models from Health Care Claims Data for Strategic Decision-Making. Introduction. William Bednar, FSA, FCA, MAAA
Building Actuarial Cost Models from Health Care Claims Data for Strategic Decision-Making William Bednar, FSA, FCA, MAAA Introduction Health care spending across the country generates billions of claim
Baptist Health System and HealthTexas Medical Group Network San Antonio, TX Medical plans at-a-glance for businesses with employees
Baptist Health System and HealthTexas Medical Group Network San Antonio, TX Medical plans at-a-glance for businesses with 2 100 employees Aetna Whole Health SM EPO Plans TX Gold AWH EPO 500 80/60 (2 50)
CONNECTICUT GENERAL LIFE INSURANCE COMPANY a CIGNA company (called CG) CERTIFICATE RIDER
Home Office: Bloomfield, Connecticut Mailing Address: Hartford, Connecticut 06152 CONNECTICUT GENERAL LIFE INSURANCE COMPANY a CIGNA company (called CG) CERTIFICATE RIDER No. CR7BIASO5-3 Policyholder:
Health Care Financing Reform in the United States
Health Care Financing Reform in the United States Richard M. Scheffler,, PhD Distinguished Professor of Health Economics and Public Policy Director of the on Healthcare Markets and Consumer Welfare University
Reinsurance / Stop-Loss and How You Can t Live Without It In Risk
Reinsurance / Stop-Loss and How You Can t Live Without It In Risk Facilitated by: John P. Schmitt, Ph.D, FASHRM Managing Director Reliance Consulting Group October 13, 2016 = General Session = Introductions
QPP Other Payer Advanced APMs: CMMI Multi-Payer Model Payer Perspective
QPP Other Payer Advanced APMs: CMMI Multi-Payer Model Payer Perspective OCTOBER 30, 2017 Crystal Gateway Marriott Hotel Arlington, VA Laura Mortimer Public Health Analyst at Center for Medicare and Medicaid
Some of the services this plan doesn t cover are listed on page 5. See your policy Yes plan doesn t cover?
Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage for: Individual Plan Type: Network This is only a summary. If you want more detail about your coverage and costs, you can
Health Benefits Simplified
Health Benefits Simplified What you need to do: What s inside: Review this benefit overview Benefit Highlights 3. 4. Turn in all completed paper forms to your Human Resources Department. Complete the HealthEZpay
Quarterly. Paul Masterson at
GENESISS HEALTHCARE SYSTEM Quarterly Financial Disclosure Statement As of and for the Three Months Ended March 31, 2016 PLEASE NOTE THAT THIS DOCUMENT INCLUDES MANAGEMENT S DISCUSSION AND ANALYSIS, AS
: Federal Employees Standard Option Coverage Period: 01/01/ /31/2017 Summary of Benefits and Coverage
This is only a summary. Please read the FEHB Plan brochure (RI 73-815) that contains the complete terms of this plan. All benefits are subject to the definitions, limitations, and exclusions set forth
Important Questions Answers Why this Matters: What is the overall deductible? Are there other deductibles for specific services?
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.avmed.org/go/state or by calling 1-888-762-8633 Important
Calendar Year Medical Deductible Calendar Year Out-of-Pocket Maximum $2,000 per individual / $4,000 per family Lifetime Benefit Maximum
An independent member of the Blue Shield Association Access+HMO Per Admit 20-500 Benefit Summary (For groups of 101 and above) (Uniform Health Plan Benefits and Coverage Matrix) Blue Shield of California
Benefit modifications for members with Full PPO /60
An independent licensee of the Blue Shield Association A17436 (01/2017) Benefit modifications for members with Full PPO 250 80/60 Effective January 1, 2017 The Full PPO 250 80/60 plan name will be changed
40% (Not subject to the Calendar-Year Deductible) CT scans, MRIs, MRAs, PET scans, and cardiac diagnostic
An independent member of the Blue Shield Association P.C. Specialists dba Technology Integration Group Custom Shield PPO Combined Deductible 30-1250 90/60 Benefit Summary (For groups of 300 and above)
AvMed Network: $1,500 individual / $3,000 family Doesn t apply to preventive care. What is the overall deductible?
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.avmed.org or by calling 1-800-376-6651. Important Questions
Employee Benefit Plan: Missoula County Public Schools Coverage Period: 01/01/ /31/2014 Summary of Benefits and Coverage:
Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage for: Individual Plan Type: HDHP This is only a summary. If you want more detail about your coverage and costs, you can get
Buy-Up 500 Core 1000 HDHP Services In-Network 1 In-Network 1 In-Network 1 Calendar Year Deductible - Individual - Family $500 $1,500 $1,000 $3,
Coverage Effective November 1, 2015 Buy-Up 500 Core 1000 HDHP 1300 1 Employee $65.00 $29.50 $18.63 Employee + Spouse $143.00 $79.22 $54.21 Employee + Child/ren $129.00 $60.10 $40.52 Family $207.00 $113.65
Milliman RBRVS for Hospitals
Milliman RBRVS for Hospitals Will Fox, FSA, MAAA Ed Jhu, FSA, MAAA Charlie Mills, FSA, MAAA Kevin Frodsham, ASA, MAAA What is RBRVS for Hospitals? The Milliman RBRVS for Hospitals Fee Schedule provides
I. PLAN DESCRIPTIONS. A. POS Point of Service
I. PLAN DESCRIPTIONS A. POS Point of Service The Partnership Plan offers a single point of service plan to provide healthcare services both within and outside a defined network of Providers. No referrals
1199SEIU Greater New York Benefit Fund Summary of Benefits and Coverage: What This Plan Covers and What It Costs
1199SEIU Greater New York Benefit Fund Summary of Benefits and Coverage: What This Plan Covers and What It Costs Coverage Period: Beginning 09/01/2015 Coverage for: Medicare-Eligible Retirees with 25 Years
Shield Spectrum PPO Plan 750 Value
Shield Spectrum PPO Plan 750 Value Benefit Summary (For groups 2 to 50) (Uniform Health Plan Benefits and Coverage Matrix) Blue Shield of California Life & Health Insurance Company Effective July 1, 2012
Disease Management Initiative. Legislative Authorization. Program Objectives
Disease Management Initiative Chronic diseases such as cardiovascular disease, asthma, hypertension, cancer, diabetes, depression, and HIV/AIDS are among the most prevalent, costly, and preventable of
Summary of Benefits. Custom PPO Combined Deductible /60. City of Reedley Effective January 1, 2018 PPO Benefit Plan
Blue Shield of California is an independent member of the Blue Shield Association Summary of Benefits Custom PPO Combined Deductible 35-500 80/60 City of Reedley Effective January 1, 2018 PPO Benefit Plan
Important Questions Answers Why this Matters:
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the plan document at http://www.osc.ct.gov/benefits/docs/plandocumentfinal1012015.pdf. Important
Important Questions Answers Why this Matters:
Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage for: Individual Plan Type: Premium Plan This is only a summary. If you want more detail about your coverage and costs, you
Alaska Comprehensive Chronic & Acute Medical Cost Reduction and Containment Program. Presentations By: David Morgan and Ross Bieling
Alaska Comprehensive Chronic & Acute Medical Cost Reduction and Containment Program Presentations By: David Morgan and Ross Bieling Foreword: It is not easy being and Healthcare Economist. Business executives
September 2013
September 2013 Copyright 2013 Health Care Cost Institute Inc. Unless explicitly noted, the content of this report is licensed under a Creative Commons Attribution Non-Commercial No Derivatives 3.0 License
2018 Summary of Benefits
2018 Summary of Benefits Advantage (HMO SNP) H9915, Plan 007 and 010 H9915_18_3009 Accepted SUMMARY OF BENEFITS January 1, 2018 December 31, 2018 This Summary of Benefits booklet gives you a summary of
Summary of Benefits. January 1, 2018 December 31, Providence Medicare Harbor + RX (HMO) Providence Medicare Summit + RX (HMO-POS)
Summary of Benefits January 1, 2018 December 31, 2018 These Plans are available in Snohomish and King Counties in Washington. 2018 Advantage Plans is an HMO, HMO-POS, and HMO SNP plan with a Medicare and
Small Group HMO Coverage Period: Beginning on or after 05/01/2013
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.avmed.org. or by calling 1-800-376-6651. Important Questions
Important Questions Answers Why this Matters: What is the overall deductible? Are there other deductibles for specific services?
Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage for: Individual Plan Type: Prev. Plus Plan This is only a summary. If you want more detail about your coverage and costs,
Clinic Comparison Reporting. June 30, 2016
Clinic Comparison Reporting June 30, 2016 Agenda Introduction and Background Meredith Roberts Tomasi, Q Corp Program Director Measures, Methodology and Reports Doug Rupp, Q Corp Senior Analyst Application
Health Choice Schedule of Benefits. Intended For GuideStone Participant Use Only
Health Choice 1000 Schedule of Benefits CIGNA" is a registered service mark of CIGNA Intellectual Property, Inc., licensed for use by CIGNA Corporation and its subsidiaries. CIGNA Corporation is a holding
Important Questions Answers Why this Matters:
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.askallegiance.com/mckinney or by calling 1-855-999-1054.
OPERATIONS BULLETIN. Date: February 13, 2015 Geisinger Gold Participating Providers Re: Geisinger Gold 2015
OPERATIONS BULLETIN Date: February 13, 2015 To: Geisinger Gold Participating Providers Re: Geisinger Gold 2015 Geisinger Gold 2015 Product Line Geisinger Gold serves more than 79,000 members in 40 counties
American Health Policy Institute (AHPI) is a non-partisan 501(c)(3) think tank, established to examine the impact of health policy on large
By Tevi D. Troy American Health Policy Institute (AHPI) is a non-partisan 501(c)(3) think tank, established to examine the impact of health policy on large employers, and to explore and propose policies
Scott & White Health Plan: ERS Coverage Period: 9/1/2015 8/31/2016 Summary of Benefits and Coverage:
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.ers.swhp.org or by calling (800) 321-7947, TTY (800)
Benefit Highlights. CALIFORNIA Alameda, Los Angeles, Orange, Riverside, San Bernardino, San Diego, San Joaquin, Santa Clara 01/01/ /31/2016
2016 Benefit Highlights CALIFORNIA Alameda, Los Angeles, Orange, Riverside, San Bernardino, San Diego, San Joaquin, Santa Clara 01/01/2016 12/31/2016 TO ENROLL OR LEARN MORE: CALL 1-866-999-3945 (TTY 1-800-735-2929)
Florida Medicaid Non-Reform HMO Program
Florida Medicaid Non-Reform HMO Program September 2011 August 2012 Draft Capitation Rates Presented by John D. Meerschaert, FSA, MAAA Principal and Consulting Actuary Steven G. Hanson, ASA, MAAA Actuary
In accordance with Act 124 of 2018 (H.914)
State of Vermont Green Mountain Care Board 144 State Street Montpelier VT 05620 Report to the Legislature REPORT ON THE GREEN MOUNTAIN CARE BOARD S PROGRESS IN MEETING ALL-PAYER ACO MODEL IMPLEMENTATION
Health Care Plan Open Enrollment
Health Care Plan Open Enrollment 2017-18 Agenda ACA Update Benefits update Health Care plan review Tips to save health care dollars FSA Open Enrollment Dental Open Enrollment Vision Open Enrollment Employee
CHILDREN'S HOSPITAL AND HEALTH SYSTEM, INC. AND AFFILIATES CONSOLIDATED FINANCIAL REPORT MARCH 2017
CHILDREN'S HOSPITAL AND HEALTH SYSTEM, INC. AND AFFILIATES CONSOLIDATED FINANCIAL REPORT MARCH 2017 CONSOLIDATED FINANCIAL REPORT TABLE OF CONTENTS Management Discussion and Analysis of Financial Performance
INFORMATION ABOUT YOUR OXFORD COVERAGE
OXFORD HEALTH PLANS (CT), INC. INFORMATION ABOUT YOUR OXFORD COVERAGE PART I. REIMBURSEMENT Overview of Provider Reimbursement Methodologies Generally, Oxford pays Network Providers on a fee-for-service
Important Questions Answers Why this Matters:
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.healthplan.memorialhermann.org or by calling 1-888-594-0671.
The Case For Value ACA to MACRA to MIPS
The Case For Value ACA to MACRA to MIPS 2016-2019 Robert E Nesse M.D. Professor of Family Medicine Mayo Medical School Senior Director of Health Care Policy and Payment Reform nesse.robert@mayo.edu What
10/17/2014 Risk-Based Payment Methodologies A National Perspective Art Jones, MD. AccountableCareInstitute.com
10/17/2014 Risk-Based Payment Methodologies A National Perspective Art Jones, MD FQHCs Bridge the Gap in Care Bridge Built and Maintained by FFS Dollars 2 CMMI View of FFS Medicine 3 Accountability High
Cigna Health and Life Insurance Co.
SUMMARY OF BENEFITS Kass Shuler, P.A. Open Access Plus - Preferred www.mycigna.com Member Services 866-494-2111 Cigna Health and Life Insurance Co. Notice of Grandfathered Plan Status This plan is being
Consumer Directed Health Care: A Look at Current Experience
Consumer Directed Health Care: A Look at Current Experience November 16, 2006 Presented by: Bill O Brien, FSA, MAAA Principal Discussion Topics A quick look at historical and current trends At the beginning
Effective: July 1, Highlights: A description of the prescription drug coverage is provided separately. Participating Providers 1
High Desert & Inland Trust Custom PPO 3 Benefit Summary (For groups of 300 and above) (Uniform Health Plan Benefits and Coverage Matrix) Blue Shield of California Effective: July 1, 2016 THIS MATRIX IS
Health Care Plan Open Enrollment
Health Care Plan Open Enrollment 2016-17 Agenda ACA Update Benefits update Health Care plan review Tips to save health care dollars FSA Open Enrollment Dental Open Enrollment Vision Open Enrollment Employee
Consumer Price Transparency Examples State and National Websites
Consumer Price Transparency Examples State and National Websites State Consumer Health Information and Policy Advisory Council Meeting March 24, 2016 Health Transparency Websites What do consumers want
Summary of Benefits City of Santa Monica Custom Trio HMO Per Admit
Summary of Benefits City of Santa Monica Custom Trio HMO Per Admit 20-100 City of Santa Monica Effective January 1, 2019 HMO Benefit Plan This Summary of Benefits shows the amount you will pay for Covered
A Basic Understanding of Medicare and Medicare Plans in 12 Questions. Understanding the Basics to Make the Best Choices
A Basic Understanding of Medicare and Medicare Plans in 12 Questions Understanding the Basics to Make the Best Choices Objective Medicare can be a Mystery. Following a Heuristic approach, the Objective
What is the overall deductible? Are there other deductibles for specific services?
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.avmed.org or by calling 1-800-376-6651. Important Questions
Bending The Healthcare Trend
Bending The Healthcare Trend Mark Rosenberg & Greg Alonzo May 2018 High Performance Employer Summit Today s Discussion More than just cost-shifting What we are seeing Keys to successful cost containment
2019 Summary of Benefits
Your health. Our focus. 2019 Summary of Benefits Health Partners Medicare Special (HMO SNP) 2019 Summary of Benefits Health Partners Medicare (H9207) Health Partners Medicare Special (HMO SNP) (plan 004)
Annual Notice of Changes for 2016
Secure Blue Idaho, (PPO) offered by Blue Cross of Idaho Care Plus, Inc. Annual Notice of Changes for 2016 You are currently enrolled as a member of Secure Blue Idaho (PPO). Next year, there will be some
Health Service System Board
Health Service System Board Q2 2013 Dashboard Summary Report A Review of City Plan Inpatient, Outpatient, and Rx Trends November 14, 2013 Prepared by Aon Hewitt Health and Benefits Introduction This report
GENESIS HEALTHCARE SYSTEM
GENESIS HEALTHCARE SYSTEM Quarterly Financial Disclosure Statement As of and for the Six Months Ended June 30, 2013 PLEASE NOTE THAT THIS DOCUMENT INCLUDES MANAGEMENT S DISCUSSION AND ANALSYIS, AS WELL
San Bernardino City USD Shield Spectrum PPO SM /70
An Independent member of the Blue Shield Association San Bernardino City USD Shield Spectrum PPO SM 250-90/70 Benefit Summary (For groups of 300 and above) (Uniform Health Plan Benefits and Coverage Matrix)
You don t have to meet deductibles for specific services, but see the chart starting on page 2 for other costs for services this plan covers.
Massachusetts The Harvard Pilgrim HMO Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage Period: 01/01/2017 12/31/2017 Coverage for: Individual + Family Plan Type: HMO This
Summary of Benefits. FirstMedicareDirect HMO Standard (HMO) H
2017 Summary of Benefits FirstMedicareDirect HMO Standard (HMO) H6306-003 This is a summary of drug and health services covered by FirstMedicare Direct HMO Standard January 1, 2017 - December 31, 2017
Important Questions Answers Why this Matters:
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.crystalrunhp.com or by calling 1-844-638-6506. Important
What is the overall deductible? Are there other deductibles for specific services?
Standard Gold Point-of-Service (POS) : POS HD 1000 Gold Coverage Period: 2014 This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy
Medical Plan (Effective ) BENEFIT IN-NETWORK (PPO) OUT-OF-NETWORK (NON-PPO)
GENERAL PROVISIONS (Includes ) Deductibles (Medical and Prescription Drug) Annual Out-of-Pocket Maximum A $125 per person per calendar year deductible for medical services (maximum of 3 medical deductibles
Summary of Benefits Boone County
Summary of Benefits 2017 Boone County Y0027_16-093_EN CMS Accepted 08/30/2016 Summary of Benefits January 1, 2017 December 31, 2017 This booklet gives you a summary of what we cover and what you pay. It
Blue Care Elect $250 Deductible Coverage Period: on or after 07/01/2016 Summary of Benefits and Coverage: What this Plan Covers & What it Costs
Blue Care Elect $250 Deductible Coverage Period: on or after 07/01/2016 Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage for: Individual and Family Plan Type: PPO This is
2018 CareOregon Advantage Star (HMO) Summary of Benefits
2018 Summary of Benefits For Oregon counties: Clackamas, Columbia, Multnomah and Washington H5859_1099_CO_3018v3 CMS ACCEPTED CAREOREGON ADVANTAGE STAR (HMO) (A Medicare Advantage Health Maintenance Organization
Glossary of Health Coverage and Medical Terms x
Glossary of Health Coverage and Medical Terms x x x This glossary defines many commonly used terms, but isn t a full list. These glossary terms and definitions are intended to be educational and may be
SUMMARY OF BENEFITS. Cigna Health and Life Insurance Co.
SUMMARY OF BENEFITS Ohio Associated Enterprises Health Savings Account Open Access Plus www.mycigna.com Member Services: (866) 494-2111 Cigna Health and Life Insurance Co. General Services In-Network Out-of-Network
SecurityBlue HMO. Link to Specific Guidance Regarding Exceptions and Appeals
SecurityBlue HMO Conditions and Limitations Potential for Contract Termination Disenrollment Rights and Instructions Exceptions, Prior Authorization, Appeals and Grievances Out-of-Network Coverage Quality
Yes, written or oral approval is required, based upon medical policies.
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.uhc.com/calpers or by calling 1-877-359-3714. Important
2018 Retiree Medical Premiums and Coverage Summary MAP Plus - Option 1 Low Deductible
MAP Plus - Option 1 Low Deductible You and your SP of Record/DP of Record both are Pre-Medicare Eligible Retiree + + $462.00 $923.00 $923.00 $1,385.00 You are Medicare Eligible and your SP of Record/ DP
Coverage for: All Coverage Tiers Plan Type: POS. 1 of 9
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.paramounthealthcare.com or by calling 1-800-462-3589.
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.networkhealth.com/benefits/sbc/individualpolicy.pdf or
2019 Summary of Benefits Medicare Advantage Plans with Part D Prescription Drug Coverage
2019 Summary of Benefits Medicare Advantage Plans with Part D Prescription Drug Coverage Plus H1035-002 H1035-006 H1035-014 January 1, 2019 December 31, 2019 The plan's service area includes: Flagler and
You can see the specialist you choose without permission from this plan.
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.crystalrunhealthinsurancecompany.com or by calling 1-844-638-6506.