Description: Presenters discuss the differences between patient treatment protocols and length-of-stay guidelines, and some of the issues that payers confronted as the protocols were implemented. From the Record of the Society of Actuaries, Vol. 24, No. 2.

Description: Actuaries are increasingly being called upon to advise management about the value of medical management programs and interventions. This session discusses disease management outcome measurements and the cost vs value issues. From the Record of the Society of Actuaries, Volume 30, No. 1, Session 111

Description: Panelist discuss lifestyle issues and their effects on medical costs, both for managing costs and for making decisions about plan design. Topics include employer responses, lifestyle-based profiling, and obesity. From the Record of the Society of Actuaries, Vol. 31 No. 2, Session 27

Description: This paper applies the principles and methodologies discussed in earlier papers in this series to measure cost savings from a two-year disease management DM program for the 200,000 Medicare members of a regional managed care plan. We then study how savings estimates change when we allow for four variations in key assumptions: methods for identifying or excluding plan members, requirements for eligibility in the health plan, methods for calculating health care trend and study design. Finally, we also examine the sensitivity of these results to product type by comparing the Medicare results to those of the Commercial HMO/POS product. Paper 8 of an 8 paper series titled: “Evaluating the Results of Care Management Interventions: Comparative Analysis of Different Outcomes Measures” sponsored by the Society of Actuaries’ Health Section and the Committee on Knowledge Extension Research.

Description: Discussion of the separate and joint effects of obesity and diabetes on disability and mortality, and ways these effects can be used to improved insurance pricing and reserving, reverse the increasing rates of obesity and diabetes, and improve current projections of disability and mortality risks.

Description: Panelists discuss the successes and shortcomings of disease management as the latest generation of effective managed care. From the Record of the Society of Actuaries, Vol. 24, No. 2.

Description: This is the abstract for the paper, Measuring DM Program Outcomes: The Use of Incident and Prevalent Populations by Ying Liu, MS and Michael Cousins, PhD.

Description: Panelists continue their discussion of a research project into actuarial issues and financial measurements related to disease management programs. Outcomes measurement is specifically discussed. From the Record of the Society of Actuaries, Vol. 31, No. 2, Session 41

Description: Duncan's personal reflections on the state of care management evaluation.

Description: While there are many approaches currently being taken to transform health care, to be successful, we know that leading and planning for quality improvement is a science. Data is the common denominator as healthcare organizations establish best-practices, and ultimately overcome unintended variation through strong analytic systems. Health care leaders require specialized data analysis education and training to hone their skills in understanding and managing clinical variation. The problem with unexplained variation in healthcare is that it negatively impacts clinical outcomes, increases the cost of care, and diminishes value for patients. In this session, Dr. Ted James (BIDMC and Harvard Medical School Faculty) will explain how actuaries can offer practical solutions that provide insights into variations in clinical practice that cannot be explained by differences in medical conditions or patient preferences.