Description: A proposal to reform the health care provider payment system through: a national fee schedule, shifting more reimbursements to primary care providers, better integration of hospital & physician fees, evidence based care, pay for performance, and a better provider risk sharing mechanism.

Description: This article from major US payers describes palliative care as a scaleable means of improving quality and reducing costs during serious and complex illness.

Description: As actuaries in health care, we spend most of our time focused on reviewing claims, enrollment and clinical data. That information is captured while patients are in health care facilities. Yet most people spend only a small fraction of their time in these facilities. This article explores what types of data are available to actuaries the provide a more holistic view of the member so that a members physical and emotional needs, the social determinants of health can be taken into consideration along with their clinical needs. Two uses cases are presented so actuaries can see how these types of analyses can be leveraged to improve clinical, operational, and financial performance of risk bearing health entities. Understanding the customer (member) not just the patient enables actuaries to provide new insights and values to our stakeholders across a wide range of business and risk applications.

Description: Presenter discusses issues related to alternative care, as well as SOA activity in regard to alternative care. From the Record of the Society of Actuaries, Vol. 24, No. 1.

Description: Methods and assumptions used in the valuation of savings by external care vendors

Description: Panelists discuss major reforms of health care financing and delivery systems around the world. From the Record of the Society of Actuaries, Vol. 24, No. 2.

Description: Review of a research project, co-sponsored by the SOA, which examined 83 organizations and over 150 programs that measure the quality and efficiency of hospitals and physicians.

Description: A proposal to address provider payment issues by gradually moving to accountable care organizations. Capitations would be risk-adjusted, non-capitated costs would be covered by hospitalization fund and stoploss, incentives for quality & effective preventive care would be tied to the amount remaining in the fund, and government involvement would be through incentives rather than mandate.

Description: Overview of public health (responsibilities, funding, challenges) and discussion of the role actuaries can play in achieving population health goals.

Description: Essential Health Benefits and Actuarial Value