Karena Weikel

Ventricle Health chose Humbi because “Humbi ... provided us with decades of high-level experience. They lead a team of actuaries and data scientists that we have complete confidence in.” https://lnkd.in/eH-V-M-9 #DataAnalysisHealthcare #ActuariaConsultinglServices #ActuarialIntelligence #Ventricle #VentricleHealth

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#MedicareAdvantage keeps getting more popular among seniors: #MA plans typically offer a range of supplemental benefits (like transportation/#NEMT) that can improve quality of life and health outcomes. But they are facing challenges headed into 2025, including lower star ratings, resistance from some health networks, rising healthcare costs, and a revised CMS payment model. Read our latest blog for a summary of MA changes that will impact health plans, providers, and members in the year ahead. https://hubs.li/Q02XP0700

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Since the No Surprises Act's inception, only 15% of health plans have prevailed in IDR disputes, highlighting why many insurers feel the process doesn't benefit them. However, IDR, when executed correctly, provides a fair platform for both payers and providers, and recent changes to batching policies have made it more accessible. FHAS, with over 225,000 disputes closed, is committed to a transparent IDR process, helping organizations streamline claims resolution. Learn more: https://hubs.ly/Q02W88z00 #Healthcare #IDR #NoSurprisesAct #FHAS #ClaimsResolution #Transparency #Insurance #HealthcareProviders

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In this #CCA health series webinar, presenters provide an overview of two Actuarial Standards of Practice applicable to general actuarial practice – ASOP 56 Modeling and ASOP 12 Risk Classification. Learn more: https://lnkd.in/gemYpWPA Speakers:  David Tuomala | Optum Brian Mullen | American Family Insurance R. Jason Reed | UnitedHealth Group Susan Pantely | Milliman #actuary #actuaries #healthcareactuaries #webinar

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A recent report by Americans for Fair Health Care (AFHC) revealed that over one-fifth (22%) of insurers failed to pay awards determined by the federal #IDR process in 2023, and 35% of payments were not made within the required 30 days. This has led to significant financial strain on #healthcareproviders, who are often forced to rely on IDR for reimbursement due to contract cancellations and other insurer actions. This report also found that 94% of insurers frequently submitted #QPA values at or below Medicare rates, skewing IDR in favor of insurers. Despite a reduction in some problematic behaviors compared to 2022, such as threats of contract terminations (down from 100% in 2022 to 53% in 2023), insurers' non-payment and delayed payment behaviors persist, exacerbating financial challenges for providers. For more detailed insights, read https://lnkd.in/eJhvT8Ea

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Explore SOA Research Institute research on individual disability income claim experience and how various diagnoses affect recovery and mortality rates. Download now and watch for phase 2: https://bit.ly/3WmGCk3. #actuaries #actuaryresearch

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The CMS Health Equity Index will impact Medicare Advantage plans, but what should you do to prepare? It's time to take action. To learn more, read this executive summary from a recent webinar at https://splr.io/6043Wn8PH #HealthEquity

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Rising rates and the complexity of insurance means patients may need more guidance understanding healthcare costs and committing to care. Help patients move forward with these tips: https://lnkd.in/gaZn6e6e

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That’s a wrap on the 24th Risk Adjustment Forum! It was great seeing you all there. If you’d like to discuss your organization’s risk adjustment strategy further or we didn’t get a chance to connect, let’s set up a time. #DataLink #Events #RiskAdjustmentForum #Ri

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Join us TODAY, 1 p.m. ET for an AHCJ webinar examining what actions states — which regulate the insurance industry and run the Medicaid programs — have taken to increase spending on primary care and what effect these efforts can have on costs. 🔗 https://lnkd.in/d6uxeH4j

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While not quite the bump received after last year’s record inflation, the health savings account limits will still receive an increase for 2025, as determined under Section 223 of the Internal Revenue Code. Learn More:https://ow.ly/tvVQ50RBWmF #HSA #HealthSavingsAccount #FinancialPlanning

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From value-based insurance design & diabetes complications to hepatitis C & HPV vaccines, WTW's Jeff Levin-Scherz addresses these #healthcare topics & more for employers to watch. https://ow.ly/sh3Z50QXT35 #EmployeeBenefits

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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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You can't spell insurance without AI. When billing insurance, Dr. Hagstrom's office manager uses #AI to send images directly to the insurance companies where there is disputable radiographic evidence verify his treatment recommendations and outcomes. Discover more examples of how AI technology can enhance productivity and patient care. https://bit.ly/4cgBnal

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You can't spell insurance without AI. When billing insurance, Dr. Hagstrom's office manager uses #AI to send images directly to the insurance companies where there is disputable radiographic evidence verify his treatment recommendations and outcomes. Discover more examples of how AI technology can enhance productivity and patient care. https://bit.ly/4cgBnal

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You can't spell insurance without AI. When billing insurance, Dr. Hagstrom's office manager uses #AI to send images directly to the insurance companies where there is disputable radiographic evidence verify his treatment recommendations and outcomes. Discover more examples of how AI technology can enhance productivity and patient care. https://bit.ly/4cgBnal

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