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Milliman, FAIR Health Executives to Discuss Data-Based Rate Setting for Out-of-Network Providers in Atlantic Information Services Webinar
Date:7/14/2014

Washington, DC (PRWEB) July 14, 2014

In building products for public and private insurance exchanges, carriers emphasized lower-cost narrow-network products, accountable care organizations (ACOs) and other models. As expected, consumers generally chose coverage based on price, rather than on provider networks. But that won’t keep some enrollees from seeking care from out-of-network providers. “Using Benchmarking Data to Set Out-of-Network Rates for ACOs, Narrow Networks and Exchange Products,” the July 23 webinar from Atlantic Information Services, will provide solid strategies for navigating critical decisions regarding network design, fee schedule development and member engagement, and determining out-of-network provider rates.

Participants will hear from Robin Gelburd, president of FAIR Health, Inc., and Robert Parke, a principal and consulting actuary at Milliman. In 60 minutes of expert presentations followed by 30 minutes devoted to individual questions, they will answer these and other questions:

  • Why do health plans need a sound and defensible source of benchmark data?
  • How should benchmarking data be used to determine charges under value-based payment mechanisms such as ACOs?
  • How can benchmark data be repurposed to help build consumer education and cost and transparency tools?
  • How should health plans incorporate UCR rates for pricing narrow-network 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 pro
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