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Full-Text Articles in Insurance

Best Practices For Member Outreach And Engagement: How Effective Acos Build Understanding And Respect, Jessica Carpenter, Jocelyn Gordon Jun 2019

Best Practices For Member Outreach And Engagement: How Effective Acos Build Understanding And Respect, Jessica Carpenter, Jocelyn Gordon

Commonwealth Medicine Publications

Targeted strategies and sustained efforts at member outreach and engagement are helping Accountable Care Organizations (ACOs) and their Community Partners (CPs) achieve their shared goals for delivering patient-centered care. The most successful organizations focus on activities designed to create a stronger connection with their members, building trust and a better understanding of individuals’ characteristics and care needs. Positive results of these efforts include successful person-centered care planning, improved compliance with care plans and prescriptions, and implementation of recommended lifestyle changes — changes that help support independent living, reduce medical costs and complications, and drive improvements in member satisfaction.


University Of Massachusetts Medical School Report To Minnesota Department Of Human Services Health And Incarceration Project, Katharine London, Jeremy Tourish Jun 2019

University Of Massachusetts Medical School Report To Minnesota Department Of Human Services Health And Incarceration Project, Katharine London, Jeremy Tourish

Commonwealth Medicine Publications

On behalf of the Minnesota Department of Health Services, Health Law & Policy experts from our Public and Private Health Solutions group completed a literature review of successful efforts to improve the health of previously incarcerated individuals. In addition, our experts conducted five focus groups to obtain recommendations from experienced professionals who work directly with previously incarcerated individuals regarding interventions likely to improve the health of this unique population.

This study came about at the direction of Minnesota Legislature. They were interested in developing a methodology for paying higher rates to health care providers who provide services to high cost and ...


Payment Reform For Kids, Robert W. Seifert Feb 2019

Payment Reform For Kids, Robert W. Seifert

Commonwealth Medicine Publications

Comprehensive care for children – including greater attention to behavioral health, socio-emotional development, and strong family relationships – may hold the key to lifelong health and well-being. With this premise, a group in Connecticut has just published recommendations for improving pediatric primary care through payment reform.


Lowering Out Of Pocket Drug Costs For Consumers, Mylissa K. Price Jan 2019

Lowering Out Of Pocket Drug Costs For Consumers, Mylissa K. Price

Commonwealth Medicine Publications

Prohibiting gag clauses could help lower consumer out-of-pocket pharmacy costs - if Pharmacy Benefits Managers don't raise prices to make-up the difference. Mylissa Price closes our blog series on President Trump's Blueprint to Lower Drug Costs in this final entry.


Deciphering State Medicaid Programs, Rachel Gershon Jan 2019

Deciphering State Medicaid Programs, Rachel Gershon

Commonwealth Medicine Publications

State Medicaid programs vary substantially from one another. For members, researchers, policymakers, and advocates trying to decipher a state’s Medicaid program, this variation can be a source of frustration, because the details of this variation can be hard to locate.


How Liability Insurers Protect Patients And Improve Safety, Tom Baker, Charles Silver Jan 2019

How Liability Insurers Protect Patients And Improve Safety, Tom Baker, Charles Silver

Faculty Scholarship at Penn Law

Forty years after the publication of the first systematic study of adverse medical events, there is greater access to information about adverse medical events and increasingly widespread acceptance of the view that patient safety requires more than vigilance by well-intentioned medical professionals. In this essay, we describe some of the ways that medical liability insurance organizations contributed to this transformation, and we catalog the roles that those organizations play in promoting patient safety today. Whether liability insurance in fact discourages providers from improving safety or encourages them to protect patients from avoidable harms is an empirical question that a survey ...


Will Removing Rebates Really Lower Drug List Prices?, Stephanie Tran Dec 2018

Will Removing Rebates Really Lower Drug List Prices?, Stephanie Tran

Commonwealth Medicine Publications

The Trump Administration Blueprint to Lower Drug Prices and Reduce Out-of-Pocket Costs calls for incentives to lower drug list prices, including removing rebates. Our clinical consultant Stephanie Tran continues our pharmacy blog series with an assessment of this potential change & its impacts.


New Aca Waiver Directives Signal Changes For State Health Insurance Marketplaces, Rachel Gershon, Catherine Torri Dec 2018

New Aca Waiver Directives Signal Changes For State Health Insurance Marketplaces, Rachel Gershon, Catherine Torri

Commonwealth Medicine Publications

New Trump Administrations Section 1332 waiver guidance increases state ACA flexibility. Rachel Gershon & Catie Torri discuss what this could mean for health care policy.


Better Negotiations Between Payers And Manufacturers In An Effort To Reduce Drug Prices, Mckenzie Taylor Nov 2018

Better Negotiations Between Payers And Manufacturers In An Effort To Reduce Drug Prices, Mckenzie Taylor

Commonwealth Medicine Publications

Mckenzie Taylor continues our monthly conversation on the strategies presented in The Trump Administration Blueprint to Low Drug Prices and Reduce Out-of-Pocket Costs, discussing the ways new negotiations between payers and manufacturers are helping to reduce drug prices.


Why Retirement Systems Should Consider Vocational Review, Jody Simpson Nov 2018

Why Retirement Systems Should Consider Vocational Review, Jody Simpson

Commonwealth Medicine Publications

Whether the task is determining if a disability retirement applicant is prevented from performing their past public employment or whether they are able to adjust to other substantial work, administering disability benefit claims is a complex process that requires a sophisticated skill-set to ensure accurate and objective determinations. A critical component of that process is a comprehensive vocational assessment that determines a disability applicants vocational skills and abilities before a final recommendation is rendered.

Discover the value of vocational review and why it can be a critical part of the decision-making process.


The Fatal Failure Of The Regulatory State, W. Kip Viscusi Nov 2018

The Fatal Failure Of The Regulatory State, W. Kip Viscusi

William & Mary Law Review

Although regulatory agencies place high values on the benefits associated with the reduction in mortality risks due to regulations, these same agencies substantially undervalue lives in their enforcement efforts. The disparity between the valuation of prospective risks and fatalities that have occurred is often by several orders of magnitude, diminishing whatever safety incentives the regulations might have generated. A review of the practices by the major federal agencies with responsibility for product safety and occupational safety finds that the value placed on fatalities in agencies’ regulatory analyses can be a factor of 1000 times greater than the magnitude of the ...


An Analysis Of The Need For A Pilot Civil Liability Restriction System In South Korea For Marine Safety, Jae Kun Lim Nov 2018

An Analysis Of The Need For A Pilot Civil Liability Restriction System In South Korea For Marine Safety, Jae Kun Lim

World Maritime University Dissertations

No abstract provided.


Maritime Cargo Claims In Vietnam: Practical Issues And The Design Of A Virtual Consultancy Expert System Based On Artificial Intelligience To Assist Non-Lawyer Users, Thi Mai Phuong Pham, Thi Minh Hang Hoang Nov 2018

Maritime Cargo Claims In Vietnam: Practical Issues And The Design Of A Virtual Consultancy Expert System Based On Artificial Intelligience To Assist Non-Lawyer Users, Thi Mai Phuong Pham, Thi Minh Hang Hoang

World Maritime University Dissertations

No abstract provided.


How Can Improved Competition Lead To Lower Drug Prices?, Youkavet Samih Oct 2018

How Can Improved Competition Lead To Lower Drug Prices?, Youkavet Samih

Commonwealth Medicine Publications

In this installment of our blog series on "President Trump's Blueprint to Lower Drug Prices and Reduce Out-Of-Pocket Costs," our pharmacy expert Youkavet Samih discusses how creating drug competition drives down prices for consumers.


The Role Of Clinical Guidelines In A Managed Long Term Services & Supports Framework, Jessica Carpenter, Jill Morrow-Gorton Jun 2018

The Role Of Clinical Guidelines In A Managed Long Term Services & Supports Framework, Jessica Carpenter, Jill Morrow-Gorton

Commonwealth Medicine Publications

This presentation describes the managed long-term services and supports (MLTSS) national landscape since 2012 as well as some LTSS utilization trends. A key part of the presentation is our MLTSS best practice framework and the role of LTSS clinical guidelines in that framework. The presentation includes a case study.

Experts from Disability Community Services and the Office of Clinical affairs gave the presentation during a webinar hosted by the Association for Community Affiliated Plans.


Accounting For Geographic Variation In Social Security Disability Program Participation, John Gettens, Pei-Pei Lei, Alexis D. Henry May 2018

Accounting For Geographic Variation In Social Security Disability Program Participation, John Gettens, Pei-Pei Lei, Alexis D. Henry

Commonwealth Medicine Publications

There is wide geographic variation in Social Security Disability Insurance and Supplementary Security Income participation across the United States. Some policymakers and members of the public may assume that interregional administrative inconsistencies are a major reason for the geographic variation. To test this assumption, and to reveal other potential explanations for the variation, we decompose the total variation into components by examining regional differences in disability prevalence and in program participation among persons with disabilities as well as the correlation between those two factors. We further decompose the variation in participation among persons with disabilities into socioeconomic components. Our findings ...


The Pricing Impact Of Decreasing Competitiveness Of The Health Insurance Market, Lauren N. Patterson May 2018

The Pricing Impact Of Decreasing Competitiveness Of The Health Insurance Market, Lauren N. Patterson

Chancellor’s Honors Program Projects

No abstract provided.


Terrorism Risk Insurance: Is It Really Working?, Rebecca Demarest Apr 2018

Terrorism Risk Insurance: Is It Really Working?, Rebecca Demarest

Honors Projects in Mathematics

This paper investigates terrorism risk insurance in the United States as well as those programs offered in other countries throughout the world. In the United States, particular attention is devoted to the interaction of government with private insurers to maintain an effective insurance program. An analysis is performed comparing terrorism insurance before and after the attacks on the World Trade Center on September 11, 2001. The paper looks into actual terrorist events that have occurred focusing on 56 world-wide events that are associated with property losses greater than $10 million. This paper not only investigates the losses that were incurred ...


The Forfeiture Of Coverage Defenses Rule: An Economic Analysis, Tom Baker, Ezra Friedman, Kyle D. Logue Jul 2017

The Forfeiture Of Coverage Defenses Rule: An Economic Analysis, Tom Baker, Ezra Friedman, Kyle D. Logue

Faculty Scholarship at Penn Law

In liability insurance, the duty to defend is broader than the duty to cover. Thus it is possible that an insurer that has a duty to defend a suit may not have the duty to cover the policyholder's liabilities in the suit. However, if the penalty for a breach of the duty to defend is limited to actual legal costs spent by the defendant, the insurer may have an incentive to refuse to defend, even when the duty to defend is clear. This occurs because the insurer will not internalize the consequences of an inadequate defense when it ultimately ...


The Effect Of Health Insurance Coverage Expansions On Auto Liability Claims And Costs, Srikanth Kadiyala, Paul Heaton Jun 2017

The Effect Of Health Insurance Coverage Expansions On Auto Liability Claims And Costs, Srikanth Kadiyala, Paul Heaton

Faculty Scholarship at Penn Law

How do the Affordable Care Act health insurance coverage expansions affect payment for medical care provided through liability insurance, such as auto insurance? Theoretically, expanding coverage might lead to a substitution of health insurance disbursements for automobile insurance disbursements. Alternatively, expanding health insurance coverage might increase utilization of medical care, increasing auto liability claims payments. The net effect of these two mechanisms can only be determined empirically. We evaluate the health insurance-auto insurance interaction by examining the 2010 ACA dependent coverage expansion. Prior to 2010, individuals 19 and older were excluded from health insurance coverage under their parental health insurance ...


The Economic Realities Of Replacing The Affordable Care Act, Hanming Fang Mar 2017

The Economic Realities Of Replacing The Affordable Care Act, Hanming Fang

Wharton Public Policy Initiative Issue Briefs

Using simulations based on a new economic model, this brief empirically examines the pivotal mechanisms of the Affordable Care Act, such as the individual mandate, employer mandate, and premium subsidies, to inform the debate over repealing and replacing the Affordable Care Act. The research suggests that the ACA, if left intact, in the long run significantly reduces the uninsured rate. The simulations also suggest that the employer mandate is not a crucial pillar for the success of the ACA. The analysis indicates it is the premium subsidy, rather than the employer mandate or the individual mandate, that is crucial for ...


Demand For Health Insurance: Evidence From The California And Washington Aca Marketplaces, Evan Saltzman Jan 2017

Demand For Health Insurance: Evidence From The California And Washington Aca Marketplaces, Evan Saltzman

Health Care Management Papers

I estimate demand for health insurance using consumer-level data from the California and Washington ACA marketplaces. I use the demand estimates to simulate the impact of policies targeting adverse selection, including subsidies and the individual mandate. I find (1) high own-premium elasticities of —6.9 to —7.8, but low insurance coverage elasticities of —0.5 to —0.6; (2) minimal response to the mandate penalty amount, but significant response to the penalty's existence, suggesting consumers have a "taste for compliance"; (3) mandate repeal has minimal effect on consumer surplus because ACA subsidies already mitigate adverse selection by shielding ...


Mutually Assured Protection Among Large U.S. Law Firms, Tom Baker, Rick Swedloff Jan 2017

Mutually Assured Protection Among Large U.S. Law Firms, Tom Baker, Rick Swedloff

Faculty Scholarship at Penn Law

Top law firms are notoriously competitive, fighting for prime clients and matters. But some of the most elite firms are also deeply cooperative, willingly sharing key details about their finances and strategy with their rivals. More surprisingly, they pay handsomely to do so. Nearly half of the AmLaw 100 and 200 belong to mutual insurance organizations that require member firms to provide capital; partner time; and important information about their governance, balance sheets, risk management, strategic plans, and malpractice liability. To answer why these firms do so when there are commercial insurers willing to provide coverage with fewer burdens, we ...


In Defense Of The Restatement Of Liability Insurance Law, Tom Baker, Kyle D. Logue Jan 2017

In Defense Of The Restatement Of Liability Insurance Law, Tom Baker, Kyle D. Logue

Faculty Scholarship at Penn Law

For most non-contractual legal claims for damages that are brought against individuals or firms, there is some form of liability insurance coverage. The Restatement of the Law Liability Insurance is the American Law Institute’s first effort to “restate” the common law governing such liability insurance policies, and we are the reporters. In a recent essay funded by the insurance industry, Yale Law Professor George Priest launched a strident critique of the Restatement project, arguing that the rules adopted in the Restatement:

(a) are radically contrary to existing case law,

(b) have a naïve “pro-policyholder” bias that ignores basic economic ...


Consumer Financial Protection In Health Care, Erin C. Fuse Brown Jan 2017

Consumer Financial Protection In Health Care, Erin C. Fuse Brown

Faculty Publications By Year

There are inadequate consumer protections from harmful medical billing practices that result in unavoidable, unexpected, and often financially devastating medical bills. The problem stems from the increasing costs shifting to patients in American health care and the inordinate complexity that makes health care transactions nearly impossible for consumers to navigate. A particularly outrageous example is the phenomenon of surprise medical bills, which refers to unanticipated and involuntary out-of-network bills in emergencies or from out-of-network providers at in-network facilities. Other damaging medical billing practices include the opaque and à la carte nature of medical bills, epitomized by added “facility fees,” as ...


Insurance Against Extreme Events: Pairing Short-Term Incentives With Long-Term Strategies, Howard Kunreuther Oct 2016

Insurance Against Extreme Events: Pairing Short-Term Incentives With Long-Term Strategies, Howard Kunreuther

Wharton Public Policy Initiative Issue Briefs

Consumers tend to purchase too little insurance or purchase it too late. Consequently, taxpayers wind up bearing substantial burdens for paying reconstruction costs from extreme events. The 2005 and 2012 hurricane seasons alone cost taxpayers nearly $150 billion. There is much that can be done to better facilitate the role that insurance can play in addressing losses from extreme events, both natural and man-made.


Bearing "Substantial Burdens", Amy J. Sepinwall May 2016

Bearing "Substantial Burdens", Amy J. Sepinwall

Legal Studies and Business Ethics Papers

In Hobby Lobby v. Burwell, the Supreme Court held that religious believers could establish that their free exercise was substantially burdened just so long as they—or the corporation they had formed—believed that it was.

This highly deferential stance paved the way for yet another challenge to the contraceptive mandate. In Zubik, religious organizations (ROs) contend that it is not just subsidization of contraception that can make an employer complicit in contraception use. Instead, even filling out a form registering one’s objection to the mandate can do so. The government has responded by vigorously arguing that filling out ...


Medicare Secondary Payer And Settlement Delay, Eric Helland, Jonathan Klick Jul 2015

Medicare Secondary Payer And Settlement Delay, Eric Helland, Jonathan Klick

Faculty Scholarship at Penn Law

The Medicare Secondary Payer Act of 1980 and its subsequent amendments require that insurers and self-insured companies report settlements, awards, and judgments that involve a Medicare beneficiary to the Centers for Medicare and Medicaid Services. The parties then may be required to compensate CMS for its conditional payments. In a simple settlement model, this makes settlement less likely. Also, the reporting delays and uncertainty regarding the size of these conditional payments are likely to further frustrate the settlement process. We provide results, using data from a large insurer, showing that, on average, implementation of the MSP reporting amendments led to ...


Tort Reform And Accidental Deaths: Is There A Link?, Haley Tipsord Apr 2015

Tort Reform And Accidental Deaths: Is There A Link?, Haley Tipsord

Georgia State Undergraduate Research Conference

No abstract provided.


Time To Lift The Veil Of Inequality In Health Care Coverage: Using Corporate Law To Defend The Affordable Care Act, Seema Mohapatra Apr 2015

Time To Lift The Veil Of Inequality In Health Care Coverage: Using Corporate Law To Defend The Affordable Care Act, Seema Mohapatra

Faculty Scholarship

No abstract provided.