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  #1  
Old 03-01-2018, 07:57 PM
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Default Public Health? The triple aim?

I guess I'm getting cranky in my old age. Isn't the role for actuaries in the health sector a role related to HEALTH INSURANCE?? Public health and the triple aim are about HEALTH CARE. We are not clinicians. We are not trained in health care. We are trained in financial aspects of insurance, reserving, pricing, etc. The conflating of health care and health insurance is a HUGE problem in our country.

In fact, I would say that perhaps the biggest factor contributing to HIGH HEALTH CARE SPENDING in our country is the overuse of insurance. Rather than trying to market our skill set in more and more places even if it's harmful, perhaps we should think about our obligations to the public and talk more about the proper role of insurance, insurable events, and the HIGH levels of moral hazard that occur when "insurance" is used to finance things that people should pay for directly, such as primary care. So many personal, state and federal budgets are severely strained by the costs of coverage and care. It does not have to be this way, and we could play an important role in helping people (citizens, legislators, employers, etc, etc) understand the fundamental actuarial and economic issues.

<rant over>
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Old 03-01-2018, 09:44 PM
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I’m feeling pretty trained up on the clinical side of things.

My (biased) view is there is some room for spillover here. As these value-based programs proliferate, one thing we are seeing is more and more risk pushed down to providers. You’d like to think that you could cram down clinical risk to physicians, and have the insurers continue holding the actuarial risks, but the break isn’t clean.

That said, I’ve been on the provider side of health for six years. Most of my job is more like ‘analytics’ and ‘reporting,’ I don’t spend a ton of time solving real actuarial problems. But when actuarial problems arise, and they do, guess who is uniquely qualified?
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Old 03-02-2018, 10:49 AM
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What do you mean by "overuse" of insurance"?

I think that this means "Insurance pays for too much of the affordable/budget-able stuff that shouldn't be covered under insurance". Like:

1.) people should be doing periodically anyway (teeth cleaning, checkups, blood work, affordable meds)
2.) using the correct providers when needed (going to a quick care clinic for a cold, not the ER)

We've got the government telling insurance companies what to cover
Doctors really don't have a financial incentive to cure you

So we, as actuaries, work with what is in front of our face. We can tell all the above what can-happen-if-they-did-this-or-that but who has listened to us, EVAR?

I have more thoughts on this, but I will stop here and continue if there is a good discussion going.
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Old 03-02-2018, 11:32 AM
Dr T Non-Fan Dr T Non-Fan is online now
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I do not have "Triple Aim" on my Buzzword Bingo card.
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Old 03-02-2018, 11:36 AM
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Originally Posted by Dr T Non-Fan View Post
I do not have "Triple Aim" on my Buzzword Bingo card.
I don't hear it much any more. It seems to have been supplanted by Alternative Payment Model and Value-Based Care, at least in my circle.
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Old 03-02-2018, 12:53 PM
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Aren't those supposed to be solutions to the goal to TA (yeah, I'm calling it that, just because)?

(I'm on a call right now where initials are thrown all over without a glossary.)
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Old 03-02-2018, 01:43 PM
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Quote:
Originally Posted by Dr T Non-Fan View Post
Aren't those supposed to be solutions to the goal to TA (yeah, I'm calling it that, just because)?

(I'm on a call right now where initials are thrown all over without a glossary.)
Yeah, mostly. I think instead of the TA, people today are liking the word ‘value.’ Which typically encompasses only two of the aims. I just don’t hear TA thrown out these days.

The millennials killed the TA!!!
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Old 03-02-2018, 01:53 PM
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wiki has something about it in another page:

Quote:
CHT states that it supports the Institute for Healthcare Improvement (IHI) "Triple Aim" solutions to healthcare delivery and financing models. This model was developed by Dr. Don Berwick Founder and CEO of the IHI and consists of three elements:

Improving the patient experience of care (including quality and satisfaction)
Improving the health of populations
Reducing the per capita cost of health care [2]
Anywho, in my experience, there have been people with "great ideas" to implement in Cost Management and Utilization Manafgement, they have come to actuaries seeking the answers for, "How much will this save the company, could you include it in the forecast, and could you tell the priing actuaries to assume it when determining premium?"
yeah.

Back to the topic of why health care costs so damned much: the easy answer is that since some people get health care at a lower cost to them, everyone else has to pay more.

Also, no one seems to care all that much, until they themselves have to pay for it.
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Old 03-03-2018, 10:18 AM
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I'm just now getting out of benefits consulting but my company, for as much as we charge and tout expertise, doesn't really solve problems. We help optimize some things (which vendor where) and match you up with clinical programs but that's really it.

To me, the future comes in the form of 1) predictive analytics, 2) full consumer transparency, 3) fully-integrated, cohesive models of care.

What makes the USA different is that we also want the very best, don't want to change our lifestyles, and won't pull the plug at end of life so easily. So duh we have huge healthcare spend.

Insurers should be allowed to REQUIRE labs and/or a physical or they will not pay out in a given year. Also to REQUIRE that risk factors found (obesity, smoking) be addressed or they will not pay future claims (and that being portable - future insurers aren't required either). Essentially you waive treatment and must pay out of pocket.

I'm a visionary.
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Old 03-12-2018, 05:02 PM
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It's interesting that the Triple Aim isn't really in the lingo you hear anymore. That's one thing that's different about the setting I'm in now vs the setting that you all (presumably) are in: mine is very slow to adjust as the market / real world moves on.

Yes, by "over-insurance" I mean the use of insurance where it's not appropriate (i.e, it's very inefficient) such as for primary care or oil changes for your car.
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