Greater cost transparency and consumer engagement are front-and-center in the health insurance revolution that is underway, and the use of data is driving these monumental changes.
Data Sources for Rate-Setting in ACOs, Exchanges and Narrow Networks examines the various ways claims data can be used in the new health insurance marketplace. In addition to helping support the adjudication of out-of-network claims, claims data can provide the building blocks for ACO development, as well as the foundation for pursuing a narrow-network strategy, developing consumer-oriented tools to promote effective plan selection and plan management, and building internal dashboards for strategic decision making.
Data Sources for Rate-Setting in ACOs, Exchanges and Narrow Networks includes a comprehensive review of how FAIR Health® and other data sources can be used to determine rates for health insurance products sold via accountable care organizations (ACOs), insurance exchanges (public and private), and narrow networks. Features consumer-centric tools that allow members to have a better understanding of insurance products and their responsibility in the plan.
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Featuring a review of FAIR Health’s origins and mission as a repository of claims data, as well as the auditing and validation processes in place to ensure data integrity, this comprehensive report also addresses issues such as:
- Why do health plans need a sound and defensible source of benchmark data?
- How can benchmark data be repurposed to help build consumer education, and cost and transparency tools?
- Why are benchmark data important for exchange products?
- What models exist today for setting out-of-network rates? What are the relative advantages and disadvantages of each?
- How can chronic disease and treatment cost profiles be used to promote enrollment and informed use of benefits on the exchange?
- How should benchmarking data be used to determine charges under value-based payment mechanisms such as ACOs?
Get the tools and analytical capabilities that are becoming increasingly necessary as health care consumerism increases, ACOs proliferate, and plans with narrow networks gain traction on health insurance exchanges and elsewhere. Order Data Sources for Rate-Setting in ACOs, Exchanges and Narrow Networks today. Your order includes a PDF version emailed within 24 business hours after you order and a print version mailed to you within 5-7 business days.
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