Description: Presented at October 1985 Annual Meeting. This session discussion is about trends in utilization review 'UR', preadmission certification, concurrent review, discharge planning, retrospective review, considerations in the design or purchase of UR services, normative data and monitoring UR, recent experience of UR programs and future expectations.

Description: This article discusses the advantages, logistical concerns, and pricing formulas of implementing a TNHP, in which members pay less for treatment from providers who meet higher quality and cost-effectiveness standards.

Description: In this interview Dr. Reinhardt shares his thoughts on the role he believes actuaries should take in the health care system reforms.

Description: Presented at October 2001 Annual Meeting. Panelists provide insight into the factors driving the cost increase of prescription drugs and how these factors are being addressed. Strategies include drug utilization review, manufacturer contracting, benefit design, formularies, pharmaceutical pricing, therapeutic substitution, physical education, and introduction of new pharmaceuticals. Also discussed are pharmacoeconomic benefit considerations when studying integrated medical and pharmacy expenses.

Description: Recent health care reform activity has highlighted the importance of Clinical Integration in improving the quality, safety, efficiency and reimbursement infrastructure of the health care system. This article discusses relevance and implication of regulatory measures, implementation and data issues, and provides an end-to-end example.

Description: Presented at October 2000 Annual Meeting. Discusses the marketing of voluntary benefits to employee groups and addresses key success factors for distribution, product, and technology associated with the work-site marketing distribution channel.

Description: This article from major US payers describes palliative care as a scaleable means of improving quality and reducing costs during serious and complex illness.