Blue Shield System
Predictive Analytics in Action: Discussion of Blue Cross Shield & Blue Shield from text. From the text is below: Blue Cross and Blue Shield System (BCBS), which provides healthcare insurance to nearly 33 percent of Americans, is a successful user of predictive analytics. It has established a database that contains more than 100 million medical claims. To control increasing medical costs, BCBS uses predictive analytics to identify the risk factors that led to several chronic diseases. It also uses predictive analytics to identify individuals who are at heightened risk of getting such diseases. The goal is to be able to use the data to get doctors to provide better, more targeted care for high-risk patients, reducing their need for expensive, long-term treatment. Match.com, an online dating service, is also a successful user of predictive analytics. The company collects data from subscribers during the registration process and also by monitoring subscribers’ interactions on the website. The goal is to find the best possible matches based on each subscriber’s preferences. Using predictive analytics, Match.com matches its members based on not just their expressed preferences, but by their behavior and interactions on the website. …show more content…
Blue Cross happens to be the key health insurer in nearly every estate. Blue Cross manages at half the individual market and highest or level best third of the company’s market in a few states. The tie of Blue Cross conversions is actually bent by the biggest states BC of California and New York. Admit that alteration or modification maximize profit commission doesn’t in fact regulate the effect of these commission on how BC do actual accounts. As a whole the negotiations are fairly delicate due to non-profit insurer, which happens to be also under the financial
Victor Solis Case Summary
434 Words | 2 PagesThank you for your recent inquiry received March 31, 2017, concerning Victor Solis. Please be advised that the material provided to you contains confidential patient information and confidential information proprietary to Blue Cross and Blue Shield of Texas (BCBSTX). The release of this information to any other party is restricted by the applicable regulations under the federal Health Insurance Portability and Accountability Act (HIPAA) and Articles of the Texas Insurance Code and Chapter 159 of the Texas Occupations Code. Victor Solis has coverage under the Blue Advantage Silver HMO 102 Individual Health insurance policy effective January 1, 2017. The policy is currently active and paid through April 30, 2017.
Supplemental Medical Benefit: Case Study
662 Words | 3 PagesHi everyone! Hope all is well… Here is some important information: 1. 2014 Medicare Part B IRMAA & 2015 Medicare Part B Standard Reimbursements – Update #2 – By now, all those eligible Medicare retirees who have their pensions deposited electronically should have received their 2015 Medicare Part B standard reimbursement and, if eligible, their IRMAA reimbursements electronically (provided you applied for it in a timely fashion) on or about June 17.
North Carolina Case Study Summary
690 Words | 3 PagesAs far as the costs associated with health care, they may be concerned with the suggested payment system. Being a CCE, they are required to obtain reimbursement through a risk-adjusted, capitated basis. In addition, patients are allowed to choose health plans that best fit them and can change plans at any point. Furthermore, CCE must compete for patient based on their value and quality of service that they provide. In addition, the providers have various criteria that they must meet.
Summary Of Liberals Are Wrong
663 Words | 3 PagesMegan McCardle and Claudia Chaufan have brought many different opinions about healthcare reform. In “Liberals Are Wrong: Free Market Health Care is Possible" by Megan McCardle, she has argued that is not available for people to purchase the right and needed healthcare. Besides that, Claudia Chaufan has stated that people can purchase their own healthcare plans and also mentioned about the single-payer plan. Although having some shared ideas about health insurances, each of the authors had their significant concepts. Based on “Ken Arrow’s critique of healthcare markets”, Megan McCardle has indicated her opposition against him.
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2030 Words | 9 PagesThey also employ many of their existing members to help sell such insurance. This struck me because
Pros And Cons Of State-Care Exchanges
1130 Words | 5 PagesAlthough this is under Obamacare exchanges, it shows that state-run exchanges can effectively control the cost of premiums. A state that has efficiently and effectively controlled the health insurance markets is California. Through their state-run exchanges, California has managed to control the type and price of care provided by setting up a system that required all health insurers to provide the same deductibles and benefits within each of their coverage levels (Scheffler, Para. 7). Their plan is set up so that “insurers in all marketplaces must offer a defined set of “essential health benefits” in all plans and may offer plans at four coverage levels: platinum…followed in descending order of cost and coverage benefits by gold, silver, and bronze. ”(Scheffler, Para. 7)
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150 Words | 1 PagesThe Health Care Choice Act of 2017 (HCCA) is legislation designed to modify US policy related to the federal approach to health care. HCCA is designed to repeal the Patient Protection and Affordable Care Act (PPACA) and some provisions of the Healthcare and Education Reconciliation Act of 2010. HCCA also addresses the Public Health Service Act (PHCA) to support interstate healthcare coverage where a health insurer can insure from one state to an individual in another, and that the laws of the health insurer’s state are the laws which apply. The law exempts insurers from the laws of the secondary state (the state of an insured, if they live in another state than the insurer) (“H.R. 314”, 2017). The primary state has jurisdiction to regulate
Comparing Medicare And Long-Term Care
553 Words | 3 PagesMedicare Kelsey Reinholt SOC 400 10/22/2015 Les Lazarevic ABSTRACT The focus of this paper is to provide knowledge over the Medicare and its requirements. This paper explains some challenges that might occur with the choices on Traditional Medicare, with Medicare+Choice, there is usually an incentive financially or at least an encouragement for a transfer to the private sector for little to no cost. Medicare and Medicaid, two publicly funded health programs, both cover populations in need of long-term care, but they are poorly coordinated.
Affordable Health Care Policy Pros And Cons
975 Words | 4 PagesInsurance companies will now be accountable to their customers for how they are spending premium dollars, and how much they are raising rates.
Managed Care Case Study
858 Words | 4 PagesThe effects can be made through claiming through managed care by the organization. The managed care for the delivery and principles of finances, the patients and physicians must follow the policies and procedure of the health plans. The drug benefits in a pharmacy can be reduced in costs from 40 % to 10% comparing to people who are members and the non-members. The reimbursement if any the mechanism should be used by the MCOs that are effective. The MCOs should make sure that as much as the cost is low the services should be of a quality to make the patient keep coming.
Single Payer Health Care System
1986 Words | 8 PagesHealth care has been at the forefront of debate and public policy in the United States for decades. Ever since President Theodore Roosevelt proposed health care reform during his 1912 run for president, reform has been a policy position often espoused in American politics (Palmer 1). Certain types of health care reforms have been successfully implemented, such as Social Security in the 1930s, Medicare in the 1960s, and finally the Affordable Care Act in 2010. As the goal of the Affordable Care Act is to provide care for every American, the healthcare law is the closest the United States has ever approached to a single payer system; a health care system that provides universal care to every American. Despite that, current systems within the
Defender Direct: A Case Study
235 Words | 1 PagesAlexis is a customer service professional that has worked in a call center environment for two years. She worked for Defender Direct in three different roles. She started out as a Field Service/Disposition Agent dispatching technicians to job sites and called clients to check in on their service and/or verify if they are home if no one answered the door. She moved into the Shelling Agent role after 6 months. She would enter in client’s information into the ADT system and answered questions that the clients had about their equipment.
Obamacare Argumentative Essay
438 Words | 2 PagesOn the other hand, supporters show through statistics that Medicaid, with the latest addition of Obamacare, has benefited up to 17 million Americans since 2013. The big improvement allowed many people to be insured under the health care umbrella, they argue. Furthermore, ACA has drastically reduced the amount of people without health insurance in half a century. Despite the growth of people insured with Obamacare, the latest study by Moody’s Investors Service claims that nonprofit hospitals under this expanded Medicaid are unsatisfied with the results thus far. Instead of a result of reduced debt and monetary progress at hospitals, they face unpaid bills, and Americans paying out of their own pockets, the study says.
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955 Words | 4 PagesInsurance companies are making a huge amount of profit. The profit that these
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1459 Words | 6 PagesSignificance Of Analytics for An Adult Website At the heart of the online adult business, nonetheless, Adult SEO company are getting attracted toward data analysis for infiltrating insights of the visitor behavior for their clients as quickly as possible. The adult entertainment industry has suffered from an issue that the music business has confronted: with such a large amount of content now unreservedly accessible on the web, it no longer costs anymore. This issue is exacerbated by the way that they have customers who are especially hesitant to leave an impression of their sexual activities because of the fear of others discovering it.
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