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Actuarial Analyses

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Forecast Improvements in Health and Economic Productivity

In a cost-constrained marketplace, self-insured employers (SIEs), accountable care organizations (ACOs), and home- and community-based service (HCBS) providers need to continually evaluate the cost-effectiveness of their condition management programs.

IMC’s musculoskeletal health optimization program™ is no exception.  In relation to orthopedic conditions, few healthcare purchasers and risk-takers have had true options for improving musculoskeletal care and patient-reported outcomes while reducing unnecessary clinical demand and costs.

Well-executed condition management programs generally have favorable clinical outcomes; however—outside of IMC’s outcomes-accountable™ solutions—these results do not always translate into a favorable financial result for healthcare’s purchasers and financial risk-takers.

IMC’s programs offer a refreshing departure from past disappointments. The Company’s researchers (including actuarial, health economics, outcomes research, and comparative-effectivness experts) go beyond measuring ROI by factoring in only the cost of the program and the program’s impact on orthopedic services and costs (i.e., the “effect on medical costs”).  They offers precise calculations of economic outcomes and returns on investment (ROIs),  taking into account clinical and humanistic factors, as well as programmatic effects on other employer-provided benefits (e.g., paid time-off, group health, workers’ compensation, disability) and performance targets (e.g., revenue per employee, earnings per employee).

Anticipate Changes in Insurance Risks and Premiums

Integrated Mechanical Care (IMC) works closely with a broad range of health industry stakeholders to address actuarial concerns associated with changes in orthopedic benefits.

Stakeholders need to know:

  • Past, current, and forecast enrollment in group health, workers’ compensation, and disability programs (as well as IMC’s musculoskeletal health optimization program™);
  • The relative morbidity of historic, current, and anticipated beneficiaries with musculoskeletal disorders (MSDs) and their respective healthcare resource consumption rates by health-realted program;
  • The likely effects of new orthopedic benefit plan design, resolved MSD sufferers, and new MSD sufferers on the healthcare marketplace overall—and the orthopedic marketplace, specifically—especially in terms of stakeholders’ attitudes and behaviors, and resulting implications for the supply and demand of MSD-related self-care, healthcare, and public health services.
  • Drivers of variability in MSD-related economic, clinical, and humanistic outcomes, e.g., profiles of MSD sufferers, MSD sufferers’ orthopedic program opt-in versus opt-out decisions, primary care and orthopedic practitioner profiles, healthcare provider organization profiles, geographic considerations, cultural factors, government affairs, healthcare technology innovations (e.g., new diagnostic equipment, pharmaceuticals, implantable medical devices, or biologics [e.g., stem cell therapies]), and digital technology innovations).
  • Other factors likely to influence programmatic cost-savings, musculoskeletal health, and stakeholders’ socioeconomic opportunities.

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