Description: Panelists discuss the tools available for coping with increases in rates for managed-care health insurance, such as: improved information on specific providers [relative costs, charges, and efficiency], analysis of the value of managed-care administrative fees, The Leapfrog Group, other data-quality initiatives, and plan-design changes. From the 2002 Record of Society of Actuaries, Volume 28, No. 3. Session 149OF of the Boston Annual Meeting.

Description: Many new and innovative companies are leveraging technology to improve the effectiveness of the care provided to patients. They are employing better tools to identify patients who can benefit from specific programs that best meet the patient's need. They are also dramatically increasing the use of these programs by guiding plan members through the maze of offerings to match them with the programs that will be most beneficial to them. Employers are making these third party programs available to their members and Medicare Plans are using these new tools to identify emerging health risks for early intervention and more accurate risk scoring. This session will explore some examples of these programs, how they are being effectively integrated into the operations of health plans and how the results of these programs are being measured.The speakers will be:Raj Behal, MD, MPH,Chief Quality Officer, One Medical. Raj leads the quality and safety, value and innovation, and data science teams at One Medical. One Medical is changing the way primary care is delivered with a concierge approach with technology seamlessly woven into their offering. This includes booking appointments on line, virtual face to face care, accessible medical records and health reminders.Mylea Charval,Ph.D., CEO and Founder, Savonix. Savonix is a next generation cognitive assessment platform that brings clinical, evidence-based, and all mobile digital assessment of cognitive and emotional function. These capabilities are critical for early identification of the onset of dementia and for the proper risk assessment of seniors enrolled in Medicare Advantage Plans.Ed Cymerys, FSA, Advisor. Ed will serve as moderator. Over the last six years Ed has served as an advisor to a number of early stage technology companies looking to improve the way health benefits are being delivered.Dave Sotelo, FSA, MAAA, Actuarial Manager, Collective Health, Inc. Collective Health is an integrated solution that allows self-funded employers to administer their health plans, control costs, and take care of their people -- all in one place. They have effectively integrated more than 70 distinct third party solutions for self-funded employers and are rigorously assessing the impact of these programs

Description: This article describes the results of three years of work by Blue Shield of California to collaborate with hospitals and physician organizations to reduce cost and improve quality for commercial populations in targeted geographies.

Description: 1993 SOA Spring Meeting, San Diego. This session is about point-of-service plans, overview of current enrollment statistics/ tends, in-network and out network utilization patterns, trends in benefit design, employer/benefit consulting demands and employee/employer satisfaction.

Description: The US Preventive Services Task Force (USPSTF) requires that essential benefits include "intensive behavioral counseling" for overweight or obese individuals with any other cardiovascular disease risk factors. These requirements can be met through online digital programs that meet the clinical standards of the recognized Diabetes Prevention Program (DPP). This new branch of medicine-digital therapeutics-holds the key to delivering lifesaving interventions to those who need them the most. Omada Health’s Prevent is an example of one innovative product which has successfully translated behavioral interventions like DPP to an online setting. Sean Duffy focused on small-group support, personal health coaching, personalized and engaging design, DPP curriculum adherence and progress tracking-leveraging unique aspects of technology to enhance key elements of successful behavioral interventions. These scalable solutions can bene fit multiple players within the managed care ecosystem and are being seeded by health plan venture investments to help bend the cost curve across the industry.

Description: Collective Health plan sponsors found that concierge services and enhanced digital tools produced lower trend by helping members navigate more intelligently.

Description: Presented at June 1996 Spring Meeting. This is a discussion on how to decide whether to build a network or develop an alliance with an integrated delivery system.