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HCA 6913 Graduate Seminar – Healthcare Payor Entities
Commercial Insurance Reimbursements and Incentives
Article: Understanding the Basics of Commercial Health
1) Briefly describe how commercial health insurance works.
2) List and describe the different types of commercial health insurance.
3) Describe how prescriiption drug coverage is handled in commercial health
Article: Health Insurance Literacy Disparities
4) Describe how race, ethnicity and language preference can contribute to
disparities in health insurance literacy.
Article: Trends in Disenrollment and Reenrollment Within US
Commercial Health Insurance Plans, 2006-2018
5) Explain what is meant by disenrollment and turnover rates as described in the
6) What are the implications of disenrollment and turnover? In other words,
what can an insurance company do to lessen the disenrollment and turnover
Article: Restrictive Rating and Adverse Selection in Health
7) Explain the concept of Adverse Selection.
8) Describe the study’s findings in general, as well as the impact of the
Affordable Care Act, on adverse selection
Article: Wide State-Level Variation in Commercial Health Care
Prices Suggests Uneven Impact of Price Regulation
9) Prices charged for health care services in the commercial insurance market
are high and vary widely within and between market areas. As a result, prices
have been the focus of much policy debate. Summarize the major findings of
the study related to price variation among states in inpatient and outpatient
Article: A Proposal to Cap Provider Prices and Price Growth in
the Commercial Health-Care Market
10)The United States not only spends a larger share of its GDP on health care
than any other country but also has experienced more rapid health-care
spending growth over time. The high private sector health-care spending in
the United States relative to that in other developed countries is driven
mostly by higher prices.
a. Describe how price regulation could be used to constrain commercial
provider prices with relatively smaller market distortions than would
likely occur under alternative approaches, such as a public insurance
b. Describe the three-pronged approach outlined in the study to constrain
Why Don’t Commercial Health Plans Use Prospective Payment
11)Describe what is meant by Prospective Payment, i.e., what does it mean and
how does it work?
12)Describe the results of this study.