Description: Disease management [DM] is a health care intervention targeted to individuals with chronic diseases chronics. To justify the investment by payers in DM, it is important to demonstrate beneficial clinical and financial outcomes. This paper analyzes the health cost trends between the chronic and non-chronic populations. Paper 7 of an 8 paper series on 'An Introduction to Care Management Interventions and Their Implications for Actuaries'.

Description: This report compares health care utilization and expenditures between individuals with Crohn’s disease who had used infliximab and those who had not. Claims data from the 1999-2003 Thomson Reuters MarketScan commercial claims and encounters databases and inpatient, outpatient, and prescription drug claims data of individuals older than 18 years of age with a diagnosis of Crohn’s were included.

Description: In this paper, the authors created a mathematical model which reflects typical relativities by age, duration of disablement, and deferment period for disability risk. The paper is followed by discussions submitted by various reviewers.

Description: This paper explores available disability experience data in order to shed some light on the character and extent of the subjective influences which affect the frequency and duration of disability. A mathematical model for computing disability income premiums and reserves is also presented.

Description: This discussion looks at the success rate companies have in the sale of long-term disability benefits, benefits provided after plan termination, appropriate experience for determination of premiums and reserves, determination of reserve liabilities for continuing claims, and experience rating.

Description: This paper describes a modified development method for analyzing claims experience and calculating claim reserves and liabilities on short-term health insurance benefits. It identifies many of the influences on claim development and discusses various ways to recognize them. From Transactions of Society of Actuaries 1989, Vol. 41.

Description: In this paper a method is described for pricing - and reserving for- return of premium benefits under disability income policies. Followed by a discussion paper

Description: This paper examines five alternative valuation methods - prospective, retrospective, global, intermediate, and static - for the proper application of GAAP to Medicare supplement insurance. The focus of this paper is on the changes to expected future claim costs due to changes in the Medicare deductibles.

Description: This paper describes an actuarial methodology for evaluating disease management outcomes. We address several important issues in this paper: • Control of exposure, • Identification of measured populations, and • Ensuring equivalence between baseline and intervention populations. - Paper 6 of an 8 paper series on 'An Introduction to Care Management Interventions and Their Implications for Actuaries'.

Description: The purpose of the SOA project Modeling Long Term Healthcare Cost Trends for Valuation is to provide a benchmark projection of medical cost increases and provide a user-firendly model for making alternative projections. This paper presents sample output from the model, technical documentation of the model, FAQs, and a review of the literature and references.