Description: The panel at this session of the SOA 1989 Chicago Spring Meeting discusses managing ambulatory care [i.e. outpatient], physician visit frequency, multiple testing, defensive medicine and how physicians function in a manged care environment.

Description: Discusses components of health-care inflation and their impact on health-insurance products. These components include: utilization trends, consumer price index [CPI] changes, regional variation. From the 1988 Record of Society of Actuaries, Vol. 14, No. 1.

Description: This session at a SOA 1990 Spring Meeting is about open ended managed care plans from various perspectives including structure, marketing and actuarial issues.

Description: This session will explore the national landscape of state Medicaid risk adjustment program design & application and the key differences that drive effective managed care organization program management. Risk adjustment is a mechanism to adjust capitation rates between Managed Care Organizations to account for population morbidity differences. Although many states utilize this mechanism, the application of risk adjustment can vary significantly across states. The primary differences include populations, risk score models and data collection. These state application nuances affect the strategies and tactics utilized by MCOs for effective risk adjustment program management including provider financial alignment, encounter data submission and the capture of accurate diagnosis codes. The session is intended for Medicaid Managed Care Actuaries working to develop or support comprehensive risk adjustment program management functions.

Description: This is a panel discussion about the future of health care and health care insurance. From Transactions of Society of Actuaries 1968, Vol. 20 Pt. 2, No. 58

Description: This session discusses the impact of rising costs and increased litigation on managed care. From the Record of the Society of Actuaries, Volume 27, No. 1, Session 133

Description: In Medicaid rate development, actuaries have not historically shared models that developed the margin (i.e., underwriting gain) assumption. This is unfortunate, given the margin assumption is one of the most critical components of the rate development in ensuring financial solvency of the Medicaid managed care organizations (MCOs). In this session, we will discuss the primary components of the this assumption and will share working models that help actuaries quantify these components—including the cost of capital and risk (or contingency) margin. We expect a lively discussion as we “open the black box” and discuss these actuarial assumptions in the public for the first time.

Description: Panelists at this session of the SOA 1997 Palm Desert Spring Meeting discuss medical excess coverage which is provided to hospitals and/or physician groups to reimburse such groups for benefits in excess of a deductible. This coverage typically involves situations where providers are taking capitation.

Description: This discussion reviews the appropriate roles of group insurance, individual insurance and governmental programs in providing protection against the cost of medical care for retired persons and other aged citizens. From Transactions of Society of Actuaries 1961, Vol. 13, Pt. 2.

Description: This panel at the SOA 1997 Palm Desert Spring Meeting discusses how ratings and rating agencies affect health care insurance and related organizations. Advice is offered on maintaining a good relationship with rating services.