Description: Panelists discuss the following managed care topics: · Design issues/pros and cons e.g., self-directed health-care model · Provider reimbursement methodologies · Consumer and regulatory issues · Insurance and reinsurance pricing and underwriting issues · Catastrophic claims · Risk-based capital repercussions · Defined contribution health plans From the Record of the Society of Actuaries, Volume 27, No. 1, Session 61

Description: In this paper, fuzzy sets - collections of objects whose boundaries are not precisely defined - are used to model the selection process in group health insurance. Both single and multiple options plans are discussed. Discussions of this paper are included.

Description: Summary of research from the Initiative 18/11 - Pharmacy team about the drug development process for traditional pharmaceuticals: Who does the research and discovery? What does the research and discovery process entail? How are targets identified and validated for research and discovery? What are clinical trials and how are they conducted? How is the drug development process regulated? How is the drug development process funded?

Description: The presenters will explore the roles of mental health and social determinants of health in the management of a population's total health. We will explore how emerging sources of data and information have led to a renewed focus on managing mental health conditions and social determinants of health. Speakers will address current health care programs that utilize this data and information to manage the total care for populations using predictive models to improve the deployment of resources and initiatives to improve the cost of care and health of populations. The presenters will also look at how providers of care are approaching mental health co-morbidities to manage physical health and social determinants of health in the management of patients.

Description: This report is a brief summary of a symposium held in Sweden in March 1972, initiated and sponsored by the Swedish insurance companies which discusses the side effects of the development of modern chemical industry and the exposure of living organisms to a variety of chemicals in the environment. The danger of the long term effects on health are addressed.

Description: This article reviews environmental issues as discussed in The Doomsday Book by Thames and Hudson, London. From The Actuary, May 1971, Vol. 5, No. 5.

Description: Any analysis of risk assessment and risk adjustment must pay special attention to large claims. If the goal of risk adjustment is to motivate carriers to be efficient,, as opposed to motivating carriers to select the best risks,then finding a solution to the problem of compensating carriers fairly for these high-cost claimants is an absolute necessity. From A Comparative Analysis of Methods of Health Risk Assessment, M-HB96-1.ese

Description: Employer and payers need to actively seek change in the system of mental health care deliveryoperational, clinical, and financial change. From Financing Chronic Care Monograph, M-HB05-1.

Description: This article will consider several issues arising from ACO budgeting and pricing of stoploss coverage, including: 1) attribution of members; 2) claim carve outs; 3) ambiguous stoploss terms; 4) providers gaming the system and 5) credibility of data.

Description: This paper highlights the menace of overweight and obesity which are on the rise. Health care systems and insurance industries are directly affected. Liability claims are on waiting. The food related damage claims are costly. Insurers are therefore driven to find a solution: classify overweight and obesity as a group, adjust their premium to reflect the cost, and justify the classification and the adjustments.