This presentation discusses dementia including causes, evaluation of patients, planning treatment strategies and referring to available community resources. From SOA 2011 Medical School for Actuaries, Session 2

Medical School for Actuaries will address a key piece of feedback gleaned from the SOA's Untapped Opportunities market research: Actuaries can better compete with other health care professionals when they enhance their health care expertise with clinical knowledge. The session will move actuaries away from looking only at cost/utilization and investigate the underlying clinical causes of those cost and utilization patterns by investigating the medical and pharmaceutical science behind many of the most impactful chronic conditions in the health care system. The session will take a deeper dive into each chronic condition explored: What causes it? How can it be prevented? How and why does it progress? How do various treatments—medical or pharmaceutical—and lifestyle choices work to slow or speed the progression? What is the impact of co-morbidity with other diseases? The session will also explore the long-term horizon for these diseases and enable participants to ask questions of a medical professional. Alzheimer’s disease, Parkinson’s disease and

Medical School for Actuaries will address a key piece of feedback gleaned from the SOA's Untapped Opportunities market research: Actuaries can better compete with other health care professionals when they enhance their health care expertise with clinical knowledge. The session will move actuaries away from looking only at cost/utilization and investigate the underlying clinical causes of those cost and utilization patterns by investigating the medical and pharmaceutical science behind many of the most impactful chronic conditions in the health care system. The session will take a deeper dive into each chronic condition explored: What causes it? How can it be prevented? How and why does it progress? How do various treatments—medical or pharmaceutical—and lifestyle choices work to slow or speed the progression? What is the impact of co-morbidity with other diseases? The session will also explore the long-term horizon for these diseases and enable participants to ask questions of a medical professional. Alzheimer’s disease, Parkinson’s disease and adult immunizations will be among the topics discussed, as well as cost effectiveness and orthopedic issues.

Medical School for Actuaries will address a key piece of feedback gleaned from the SOA's Untapped Opportunities market research: Actuaries can better compete with other health care professionals when they enhance their health care expertise with clinical knowledge. The session will move actuaries away from looking only at cost/utilization and investigate the underlying clinical causes of those cost and utilization patterns by investigating the medical and pharmaceutical science behind many of the most impactful chronic conditions in the health care system. The session will take a deeper dive into each chronic condition explored: What causes it? How can it be prevented? How and why does it progress? How do various treatments—medical or pharmaceutical—and lifestyle choices work to slow or speed the progression? What is the impact of co-morbidity with other diseases? The session will also explore the long-term horizon for these diseases and enable participants to ask questions of a medical professional. Alzheimer’s disease, Parkinson’s disease and adult immunizations will be among the topics discussed, as well as cost effectiveness and orthopedic issues.

Summary of cost-reduction and quality improvement within the disease management sector. Paper 4 of an 8 paper series on 'An Introduction to Care Management Interventions and Their Implications for Actuaries'.

Duncan's personal reflections on the state of care management evaluation.

This paper applies the principles and methodologies discussed in earlier papers in this series to measure cost savings from a two-year disease management DM program for the 200,000 Medicare members of a regional managed care plan. We then study how savings estimates change when we allow for four variations in key assumptions: methods for identifying or excluding plan members, requirements for eligibility in the health plan, methods for calculating health care trend and study design. Finally, we also examine the sensitivity of these results to product type by comparing the Medicare results to those of the Commercial HMO/POS product. Paper 8 of an 8 paper series titled: “Evaluating the Results of Care Management Interventions: Comparative Analysis of Different Outcomes Measures” sponsored by the Society of Actuaries’ Health Section and the Committee on Knowledge Extension Research.

This paper describes seven methods used in care management in the order of their historical development: 1. Pre-Authorization 2. Concurrent Review 3. Case Management 4. Demand Management 5. Disease Management 6. Specialty Case Management 7. Population Health Management Paper 1 of a 8 paper series

This paper addresses specific details of measurement principles and practice that the actuary should consider when planning to conduct or review a study of care management interventions. Three major topics are covered: Measurement Principles, Study Design Issues, and Risk Factors. Paper 2 of an 8 paper series on 'An Introduction to Care Management Interventions and Their Implications for Actuaries'

A review of literature regarding care management program outcomes - either financial or utilization-related which are indicative of financial improvement or from which financial conclusions may be drawn. Includes a discussion on utilization & concurrent review, case & demand & population & disease management . Paper 3 of an 8 paper series on 'An Introduction to Care Management Interventions and Their Implications for Actuaries'.