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Related Concept Videos

Actuarial Approach01:20

Actuarial Approach

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The actuarial approach, a statistical method originally developed for life insurance risk assessment, is widely used to calculate survival rates in clinical and population studies. This method accounts for participants lost to follow-up or those who die from causes unrelated to the study, ensuring a more accurate representation of survival probabilities.
Consider the example of a high-risk surgical procedure with significant early-stage mortality. A two-year clinical study is conducted,...
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Decision Making: P-value Method01:09

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Preventive Healthcare Services01:30

Preventive Healthcare Services

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Preventive healthcare services keep people healthy via frequent check-ups, screening, and counseling. They primarily aid in disease prevention rather than treating an acute or chronic illness. Preventive treatment also keeps individuals productive and energetic, allowing them to work well into their retirement years. Examples of preventive care services include:
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Standards of Care I01:22

Standards of Care I

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Federal statutes profoundly impact nursing practice, providing critical guidelines to ensure patient care is equitable, accessible, and of the highest quality. The following laws address distinct aspects of healthcare provision and patient rights:
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Value Tools Not in The Insurer Toolkit-Yet.

Ed Silverman

    Managed Care (Langhorne, Pa.)
    |January 26, 2017
    PubMed
    Summary

    Current guidelines from the American Society of Clinical Oncology (ASCO) may not suit insurers. Insurers are exploring new methods to analyze healthcare costs and patient outcomes.

    Area of Science:

    • Health economics
    • Clinical oncology
    • Healthcare policy

    Background:

    • Current clinical guidelines, such as those from the American Society of Clinical Oncology (ASCO), are primarily designed for clinical decision-making.
    • Insurers face challenges in utilizing existing guidelines for their specific needs related to cost-effectiveness and value-based assessments.

    Purpose of the Study:

    • To explore the limitations of current clinical guidelines for insurance providers.
    • To identify the need for novel approaches in analyzing healthcare costs and outcomes from an insurer's perspective.

    Main Methods:

    • Analysis of existing ASCO guidelines and other relevant clinical standards.
    • Review of insurance industry requirements for cost and outcomes data.
    • Exploration of potential new methodologies for data analysis.

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    Main Results:

    • Existing guidelines may not adequately address the financial and value-based considerations crucial for insurers.
    • Insurers are actively seeking innovative analytical frameworks to evaluate healthcare interventions.

    Conclusions:

    • A gap exists between clinical guideline development and the specific analytical needs of insurance providers.
    • Development of tailored analytical tools is necessary for insurers to effectively manage costs and assess outcomes.