Actuarial Science Meets Healthcare Innovation with Frank Cheung
Sep 23, 2024
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Frank Cheung, Co-Founder and CEO of Accorded, has a rich background in risk management and value-based care, having worked with major healthcare organizations. He discusses the essential role of actuarial science in value-based models, sharing insights from his journey in founding Accorded. Frank also addresses challenges startups face in healthcare innovation, particularly in navigating insurance coverage and claims data. His advice highlights the importance of marrying clinical benefits with economic rationale to drive successful healthcare solutions.
Actuaries play a pivotal role in healthcare by modeling financial outcomes and managing risks to ensure fair compensation structures.
The transition to value-based care blurs the lines between payers and providers, increasing the demand for actuarial capabilities in managing risks and costs.
Deep dives
The Role of Actuaries in Healthcare
Actuaries play a crucial role in the healthcare system, primarily functioning as data scientists and financial analysts within the insurance framework. Their responsibilities include modeling financial outcomes, pricing, and managing risk associated with healthcare expenditures. By analyzing claims data alongside other relevant information, actuaries help ensure that insurers accurately assess the consumption of healthcare services, thereby facilitating fair compensation structures between payers and providers. This oversight is essential to maintain a balanced system where the money flowing in corresponds with the expenditures going out, ultimately helping organizations make informed business decisions.
The Shift Towards Value-Based Care
The healthcare landscape is increasingly moving away from traditional fee-for-service models toward value-based care, which requires providers to take on more risk similar to insurers. This shift has blurred the lines between payers and providers, leading to a growing demand for actuarial capabilities within healthcare organizations. As providers are now being encouraged to manage costs and patient outcomes more effectively, the role of actuaries has expanded to include assisting healthcare systems in understanding financial risks and modeling appropriate payment structures. Consequently, the evolving healthcare market necessitates that both payers and providers adopt a more integrated approach to risk management, which can greatly benefit from actuarial insights.
Innovating Actuarial Processes
Innovators aiming to introduce new healthcare technologies must consider both clinical effectiveness and the economic implications of their solutions to secure insurance coverage. Understanding how their innovations can translate into cost savings and improved patient outcomes is vital for gaining traction with payers. Actuaries can assist start-ups by analyzing relevant data, ensuring that their clinical model aligns with business justifications that resonate with insurers. By harnessing specialized actuarial tools and analytics, companies can craft compelling narratives around their products, increasing their chances of obtaining insurance coverage and market acceptance.
Our guest today is Frank Cheung, Co-Founder and CEO of Accorded. Frank has held pivotal roles at Blue Shield of California, Deloitte, and Collective Health, leading efforts in risk management and value-based care.
Frank’s unique perspective is shaped by his extensive experience in both payer and provider settings. He has been recognized as one of the Top 50 Value-Based Care Thinkers of 2024, highlighting his significant contributions to advancing healthcare analytics and supporting innovative care models.
In this episode, we discuss the critical role of actuarial science in value-based care, Frank’s journey founding Accorded, the challenges of scaling actuarial capabilities, and his advice for startups aiming to make an impact in the healthcare industry.