
Feel free to download PDF of slides and make notes at Lecture 4
Feel free to download PDF of slides and make notes at Lecture 4
Covering over 1/2 of the US population, Employer based health insurance is a very important line of business.
Started in 2010 by ACA, the health insurance exchanges provide the ability to buy insurance by individuals and families who are not eligible to Medicaid or Employer based plans. Often there are subsidies for lower income families.
Feel free to download PDF of slides and make notes
Who the largest health insurance companies are, for each LOB. The sizes and influence of some of these companies are quite astonishing.
Medicaid and CHIP provide coverage for low income families.
Feel free to download PDF of slides and make notes at Lecture 4
Original Medicare is administered by CMS, and provides Part A hospital, Part B doctor, but no Rx coverage.
It has a nationwide provider network.
Medicare Advantage has been growing. Compared to Original Medicare, it's has lower OOP for beneficiaries.
MAPD combines hospital/doctor/Rx cover.
To thrive, MA plans must obtain a Star rating of 4 or higher.
Feel free to download PDF of slides and make notes at Lecture 4
8% of US population still uninsured.
Despite recent gains in insurance coverage, there are still a sizable number/% of US population not covered by any insurance and pay out of pocket. This is problematic on so many fronts, including public health, financial risk, human capital, health equity etc.
The Inflation Reduction Act is the latest regulatory change that will materially affect financial flows in the Part D space. More onus will shift to the health plans to incentivize more active cost containment tactics.
We covered a lot of detail! This CHEAT SHEET summarizes the key elements for each LOB, as a quick reference.
Feel free to download PDF of slides and make notes at Lecture 4
US Health System series
The 5 key elements of health plan design, that help you see and understand the whys behind each different design
View the complete course + others here ==> https://www.udemy.com/user/yidingjiang/
Learn what are decision trees in ML
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Health insurance claims data are a major source of health care data. As long as the the medical services are paid by health insurers, you will see the claims. This is a relative well structured and complete source, although clinical detail can be lacking at times.
View the complete course + others here ==> https://www.udemy.com/user/yidingjiang/
BACKGROUND
The US healthcare system spends over $4trillion per year. It is enormous and has many opportunities.
If you want to capture these opportunities, you have to be familiar with the key elements and understand why they are important.
ABOUT THIS SERIES
The US Health System is a series of courses that introduce the key elements of the US health system.
This is the Second in the series, on Payors:
Commercial – the big one
Individual / Exchange – the recent one
Private Insurer Landscape – meet the players
Medicaid CHIP – the safety net
Medicare – the complex one
Uninsured/Self pay – the problematic one
Part D IRA – the deep one
Summary – the cheat sheet
The lectures are short, concise, practical. You will see only what you really need to know.
This course will save you hours of reading boring articles, government regulations only to have more questions than answers.
ABOUT ME
I've over 20 years of experience in the health care industry. I'm a fully qualified health actuary and have a MSc in Health Policy from the London School of Economics. My goal is to help you excel in the workplace.
So CLICK ON, and let me share with you what I wish someone had showed me 20 years ago!