Description: View information on the Health Economics Module.

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: Panelists discuss employers' perspective of defining strategies to identify best-in-market opportunities. From the Record of the Society of Actuaries, Vol. 24, No. 1.

Description: This session discussed about expected trends in medical care costs, changes in Medicare reimbursement practices and their short- and long-term effects, the emerging responsibility for providing long-term care, rise of managed health care, new and old participants, selection issues, multiple options, and small group market.

Description: Panelists discuss the ongoing influence and long-term implications of the Health Insurance Portability and Accountability Act on the health insurance market in the U.S. From the Record of the Society of Actuaries, Vol. 24, No. 3.

Description: Direct Primary Care (DPC) is a newer model of primary care delivery in which patients or employers pay for care directly on a membership basis; insurance and other third-party payment is not used. Early studies show significantly improved patient health outcomes and lower expenditures for DPC patients compared with similar patients receiving traditionally delivered primary care. Additional research is needed to better understand physician perspectives about the model and the role of patient selection in early results.In this session we discuss research projects that may shed light on the DPC model and on whether early results indicate more about the model or about the patients who use it.We discuss an SoA research project that interviews DPC physicians to better understand their views about the model and its early results. We also discuss a paper that analyzes characteristics of patients who receive primary care from a DPC physician and compares them to characteristics of patients who receive primary care in more traditional ways. This cross-sectional study surveys all adult patients of a convenience sample of several DPC practices. Variables include demographics, socio-economic status (SES), type of additional coverage (if any), whether DPC fees are paid by an employer, and self-reported health status. The Medical Expenditure Panel Survey is the main source of comparison data. For a given cohort of demographics and additional coverage, we determine whether DPC patients have similar health status, demographics and SES as non-DPC patients. This study will provide insight into the degree of selection into DPC by observable patient characteristics.

Description: This article describes methodologies for detection and deterrence of Medicare fraud. It also describes the validation of PRIDIT for fraud detection in Medicare.

Description: This article talks about the new onsite clinic at Hewitt and how it benefits employees and employers.

Description: Actuaries should understand the economic considerations involved in the formulary drug decision-making process, and the presence of actuarial input in the process could improve it, especially by tying it to overall decision making for the health plan. From Prescription Drugs Monograph, M-HB04-1.

Description: Article about the future roles in health insurance.