Evaluating the Results of Care Management Interventions: Comparative Analysis of Different Outcomes Measures Claims

Research Projects – Health


By: Robert Bachler, Henry Dove, Ian Duncan, Iver Juster and Rebecca Owen

Actuaries and those responsible for the financial management of health plans are often asked to advise health plan managements on the financial and related issues concerning interventions:

  1. Was there any effect from the intervention, and can it be quantified?
  2. Should the health plan perform more or less of the specific intervention, or perhaps change the intervention target?
  3. Are there other potential interventions that may have greater value that the health plan should consider applying?

How should the actuary go about answering these questions? This study sponsored by the Society of Actuaries Health Section and the Committee on Knowledge Extension Research looks at some frequently used methodologies, defines them and evaluates their application, based on data available to the authors.

The result of the research is a series of papers, with each paper building on the ideas presented earlier in the series. Thus, papers should be read in sequential order.

Materials

An Introduction To Care Management Interventions And Their Implications For Actuaries - Paper 1: Programs and Interventions

Actuarial Issues in Care Management Evaluations

Estimating Savings, Utilization Rate Changes, and Return on Investment from Care Management Interventions - Selective Literature review of Care Management Interventions

Understanding the Economics of Disease Management Programs

Paper 5: Evaluating Disease Management Savings Outcomes

An Actuarial Method for Evaluating Disease Management Outcomes

A Comparative Analysis of Chronic and Non-Chronic Insured Commercial Member Cost Trends

Testing Actuarial Methods for Evaluating Disease Management Savings Outcomes

An Introduction To Care Management Interventions And Their Implications For Actuaries

Thank You

Members of the Project Oversight Group included:

  • Bryan Miller, Chair
  • John Cookson
  • Stacey Lampkin
  • Marjorie Rosenberg
  • John Stark

Questions Or Comments?

If you have comments or questions, please send an email to research@soa.org.