This popular reference provides a multidimensional perspective on rate setting within the HMO industry and within a framework of competitive strategy. The theory underlying rating for group health insurance products is examined, and the methods used by HMOs to set premium rates are explained.

Hmo Rate Setting and Financial Strategy

Politics & Social Sciences

Wrightson, Charles William, Jr.

Social Sciences

Amer College of

In this follow-up to his successful 1990 book HMO Rate Setting and Financial Strategy, Charles William Wrightson updates all of the information on premium rate-setting methods and includes an important new section on risk adjustment. 
This edition features: 
Two new chapters on risk adjustment methods 
Anthony Tucker, Jonathan Weiner, and Chad Abrams of Johns Hopkins University explore the tools for measuring health-based risk, applying diagnosis-based risk adjustment, and more. Melvin J. Ingber of the Centers for Medicare and Medicaid Services explores implementation of risk adjustment for Medicare. 
In-depth look at the Buyers Health Care Action Group (BHCAG) of Minnesota's Choice Plus program 
This discussion summarizes the results produced by Choice Plus and explores whether the program deserves consideration as a national model for healthcare reform. 
A brief history of the managed care industry is also provided, as well as valuable insights and projections for the future by Gordon Trapnell, a nationally recognized actuary.

Financial Strategy for Managed Care Organizations: Rate Setting, Risk Adjustment, and Competitive Advantage

Health, Fitness & Dieting

Health Administration Pr

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Books by Wrightson, Charles William, Jr.