In The Media
At Santa Barbara Actuaries, we take pride in our ongoing research and publications. The following is a sample of research projects and publications in which the associates of Santa Barbara Actuaries have been involved.
Health Talk: How to Ensure You Are Paid for the Value You Create
Ian Duncan, the president of Santa Barbara Actuaries, speaks at UCSF Rosenman Institute on March 31st, 2022. He discusses the variability of value-based contracts, the different outcomes that can occur, and how to lower the risk of underpaying or overpaying. Registration is required on the provided link below.
Medical Coding: The Language of Healthcare Reimbursement
This session will cover: the code sets used in medical coding, types of correct coding policies implemented by CMS and commercial payers, payment integrity strategies to drive health plan affordability, data analytics approaches leveraging medical coding knowledge
Health Section: Pharmaceutical Patents and Abuses
SBA Consultant Tony Pistilli, FSA breaks down his article series on pharmaceutical patents and abuses. With pharmaceutical costs continuing to accelerate the growth of overall healthcare cost, pharmaceutical patents have come under increased scrutiny by a wide range of stakeholders, including Congress. He explains how the patent system works, the effects of historical reforms, potential modern-day abuses of the system and the path forward, and how actuaries can help. (00:22:13)
Shared Savings Model Risk in the MSSP Program
The Centers for Medicare and Medicaid Services (CMS) introduced the Medicare Shared Savings Program (MSSP) for accountable care organizations (ACOs) as part of the Affordable Care Act. Participating ACOs accept risk for the financial outcomes of their assigned populations and share in gains (and, depending on the ACO model, losses) when these are generated. Payers and providers who negotiate value-based contracts need to be aware of and account for model risk in their contracts, particularly as the sizes of populations under management become smaller.
Making the Case for Your Value Proposition to Payers
Ian Duncan joins the UCSF Rosenman Institute as a guest speaker for the D-Series. In this session Ian will tell us about all the key points that healthcare companies need to take into consideration when planning their reimbursement and payer strategies.
Payment Accuracy in Value-Based Care Contracts
Reimbursement for health care services is transferring more risk away from payers and toward health care providers in the form of Alternative Payment Models (APMs), also known as Value-Based Care (VBC) models. VBC models cover a wide variety of forms but all include guarantees by providers of services to improve quality of care and/or reduce cost.
3rd Annual InsurTech Summit
Registration has opened for the 3rd Annual UCSB InsurTech Summit on Friday January 28, 2022.
SBA's Andrew Mackenzie FSA MAAA CERA will be speaking about Payment Accuracy in Value Based Care.
The 2022 Summit will be virtual-only and is free with registration.
Moss & Friends | Ep 015
SBA Consultant Maggie Richard, FSA talks about how the healthcare insurance system works, how companies calculate costs, and how the pandemic impacted the industry. (00:36:50)
Comparing Model Error Between a Standard Risk Adjustment Model and a Disease-Specific Risk Adjustment Model
Disease-specific health care interventions and programs are often evaluated with standard risk adjustment models or using more simplistic differences-in-differences approaches that are not customized for the target population. Using models specifically constructed for a target health condition population reduces the magnitude of the model error.