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May 16 Webinar Reviews the Data Sources Used for Calculating Out-of-Network Rates in ACOs, Exchanges

Washington, DC (PRWEB) May 06, 2013

Calculating out-of-network rates will be critical for competing in a health insurance marketplace where consumers are expected to choose coverage based on price, rather than on provider networks or brand recognition. Learn about the different data sources being used to do this in “Out-of-Network Rates for New Plan Models: How FAIR Health and Other Data Sources Are Being Used for ACOs, Exchanges and Narrow Networks,” the latest webinar from Atlantic Information Services, Inc. (AIS).

Private and public exchanges, accountable care organizations (ACOs) and narrow-network insurance products are about to dramatically reshape the health insurance marketplace. For health insurers and self-funded employers, the ability to engage consumers and accurately benchmark provider rates will be essential. While millions of uninsured people are expected to gain coverage beginning in 2014, the health of the overall risk pool, limits on age-ratings bands and participation fees for exchanges will pressure premiums. But since consumers are expected to choose coverage based on price, carriers will respond by emphasizing narrow-network products, cost-saving ACOs and other models.

On May 16, hear all the specifics about how FAIR Health and other data alternatives can be used for ACOs, insurance exchanges and narrow-network products. FAIR Health’s president, Robin Gelburd, and leading consulting actuary Robert Parke, a principal in the New York City office of Milliman who specializes in provider contract review and benchmarking, will discuss data-driven decision making for UCR, ACOs and exchanges. In 60 minutes of expert presentations followed by 30 minutes devoted to individual questions, the webinar will provide answers to these and other questions:

  • 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?
  • How should health plans use UCR rates to price exchange-based products?
  • 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?
  • What are the pros and cons of basing out-of-network rates on a percentage of Medicare?
  • How can cost and utilization trending over time and geography help organizations manage provider contracting and benefit design?
  • How should benchmarking data be used to determine charges under value-based payment mechanisms such as ACOs?

Visit for more details and registration information.

About AIS
Atlantic Information Services, Inc. (AIS) is a publishing and information company that has been serving the health care industry for more than 25 years. It develops highly targeted news, data and strategic information for managers in hospitals, health plans, medical group practices, pharmaceutical companies and other health care organizations. AIS products include print and electronic newsletters, websites, looseleafs, books, strategic reports, databases, webinars and conferences. Learn more at

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