Description: The essay discusses the appropriate role of insurance companies, efficient and economical ways to care for chronic illnesses and having a maximum price society will pay to support the ongoing life of any one individual.

Description: Does disease management DM positively influence health care costs? According to three prestigious sources, the answer is no. From Financing Chronic Care Monograph, M-HB05-1.

Description: This study was sponsored by the Society of Actuaries Health Section. This paper explores the relative significance of aging as a determinant of financial cost of health care beyond age 50, with particular attention to the effect for ages 65 and older. The paper presents concepts of aging factors and aging curves, which define relative values between ages for utilization or cost of health care services. General conclusions are drawn from Medicare data that utilization and cost differ by age, but that aging factors vary across services and may be less significant at very old ages. The author then turns to the question of measuring the significance of an aging curve assumption and what accuracy is lost in the simpler alternative of a single value across an age range.

Description: Republicans have promised to repeal and replace the Affordable Care Act for years. Now that they have power, what will Republican health care reform look like?

Description: Chairperson's Corner discussing actuarial principles and what we as actuaries value in our work.

Description: Conditions and required solvency standards of federal waiver to PSOs to provide Medicare+Choice products. Effect on providers, beneficiaries and employers. Issue No. 36

Description: Identifying and submitting all appropriate ICD-9 diagnosis codes to CMS will result in a higher risk score for the member and increased payments to Medicare Advantage plans. Milliman's HCC prevalence study illustrates the significant variations in HCC prevalence rates by age/gender, geography, and population type and will assist plans in benchmarking the effectiveness of their own diagnosis code capture efforts.

Description: Panel discusses the effects of reduced payment levels to many Medicare managed care organizations. From the Record of the Society of Actuaries, Vol. 24, No. 2.

Description: Discussion of the implications of the newly unveiled health care reform proposal by Senator Baucus. Key issues include abandonment of the CLASS Act, inclusion of LTC in cafeteria plans, funding and tax concerns, individual mandate, privacy concerns, play-or-pay employer mandate, impact on Medicare and Medicaid, and gridlock in the legislative finalization process.

Description: A discussion of fraud and abuse in the Medicare payment system, and steps to address these problems.