Description: This paper describes seven methods used in care management in the order of their historical development: 1. Pre-Authorization 2. Concurrent Review 3. Case Management 4. Demand Management 5. Disease Management 6. Specialty Case Management 7. Population Health Management Paper 1 of a 8 paper series

Description: Highlights of health related articles from the North American Actuarial Journal. A paper on health care reform and efficiency is published in a recent issue of the NAAJ.

Description: This presentation is a panel discussion, session 54PD, from the 2004 Spring Meeting of the Society of Actuaries, held June 14-15 in San Antonio, TX. This session covers the impact of segmentation and underwriting on expected mortality and morbidity. Panelists discuss the importance of data mining and customer selection on ultimate experience, setting up direct marketing applications with the right type of questions to maximize responses but limit risk, the use of prescription drugs and other databases, and industry practices for obtaining customer information. Discussion from participants is included. From the Record of Society of Actuaries, Volume 30, No. 2.

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: Evaluating the success of Disease Management Programs by looking at ROI and the risk management economic model. Issue No. 46.

Description: An approach to quantify medical intervention savings when medical claims data is not available by leveraging overlapping measurement techniques.

Description: Research project that reviewed and inventoried the range of quality and efficiency measures that demonstrate the performance of hospitals and physicians. Besides outlining key areas of consideration for quality and efficiency measurement, this report also describes future opportunities for actuaries and other health professionals interested in this evolving area. The inventory part of this report is in a separate document.

Description: This is a regular column highlighting articles of interest to Health Actuaries appearing in the North American Actuarial Journal.

Description: This session discusses disease management [DM] and the role of health actuaries versus economists and biostatisticians. Topics discussed include economics of DM, epidemiology strategies, and operational concerns. From the Record of the Society of Actuaries, Volume 29, No. 2, Session 21pd.