Course
Financial and Actuarial Basics
The money mechanics behind value-based care: PMPM and medical loss ratio, claims reserves and IBNR, how rates and benchmarks are set, stop-loss and risk corridors, and what it takes to bear risk responsibly.
By the end of this course, you will be able to:
- Calculate total dollars, PMPM, and member months from one another
- Explain why paid claims understate a recent period's cost, and how IBNR corrects for it
- Describe how a capitation rate or benchmark is built and what makes it adequate
- Match stop-loss and risk corridor protection to an organization's ability to absorb loss
- Evaluate the financial terms of a proposed risk arrangement before accepting it
The Language of Risk-Based Finance
PMPM, medical loss ratio, trend, and member months: the units and identities every risk-based financial calculation is built from.
Claims, Reserves, and IBNR
The care happened but the bills have not arrived. How the claims lag, IBNR, and reserves determine what a period actually cost.
Setting the Number
Rates, benchmarks, and reconciliation: how the number you are measured against is built, and why its assumptions decide the outcome in advance.
Protecting the Downside
A single catastrophic case can erase a year of savings. Stop-loss, reinsurance, and risk corridors keep variance from becoming insolvency.
The Business of Bearing Risk
Take enough risk and a provider becomes an insurer. Solvency, capital, and a practical checklist for judging a value-based deal before signing.