Description: Chairperson's note to readers.

Description: Recent health care reform activity has highlighted the importance of Clinical Integration in improving the quality, safety, efficiency and reimbursement infrastructure of the health care system. This article discusses relevance and implication of regulatory measures, implementation and data issues, and provides an end-to-end example.

Description: Disease management DM is increasingly encountered in health plans and employer groups as a health care intervention targeted to individuals with chronic diseases chronics. The untested assumption is that without DM, the chronic and non-chronic trends are identical. From Financing Chronic Care Monograph, M-HB05-1.

Description: This report is to estimate the burden of chronic disability on the U.S. elderly population, using unisex and sex-specific measures of long-term care service use, intensity and costs. It discusses disability prevalence, incidence, duration, and long-term care intensity and cost.

Description: This article discusses new opportunities for states to waive certain marketplace requirements of the Patient Protection and Affordable Care Act. The article focuses on specific opportunities for states and the role that actuaries will play.

Description: We see a problem in the long-term care insurance industry because we don’t have a standard process. The majority of agents and advisors, who sell a variety of products, are often at a loss for what to do with LTCI.

Description: More and more providers are desiring risk-based contracts instead of traditional FFS-based contracts. This session is intended to outline some of the actuarial best practices in risk-based contracting related to the many flavors of the CMS ACO programs, as well as Commercial risk-based contracts.

Description: The measure of a health-care provider's quality and efficiency can be used to reward or penalize the provider through reimbursement strategies and plan designs. Panelists discuss the measures that are becoming available. From the 2002 Record of Society of Actuaries, Volume 28, No. 2. Session 24PD of the San Francisco Spring Meeting.

Description: 1994 SOA Meeting, San Antonio. This session on physician reimbursements focused on arrangements that might be offered by managed care companies, such as HMOs. It included an overview of key definitions, concepts, and incentive compensation arrangements.