Description: This paper introduces a single measure combining cost and quality of healthcare. This is used to demonstrate the magnitude of the challenge of the increasing dependency rate. It is then used in assessing a number of alternative financing models, including user fees and alternative compensation methods for physicians. The paper documents implementation issues and evaluates the desirability of implementing these approaches in Canada.

Description: This is the inventory part of the report from the research project that reviewed and inventoried the range of quality and efficiency measures currently available for healthcare. The goal was to outline key areas of quality and efficiency measurement and identify future opportunities for actuaries. The inventory lists the resources and provides brief descriptions of their services with links.

Description: This article begins with a comparison of the commercial risk adjuster to the exisiting Medicare model, and goes on to discuss why the existing strategies employed by health plans will not work in a risk adjusted environment. The article elaborates on the importance of diagnosis coding, controlling member mix, and care management in order to mitigate risks and gain from newly created opportunities.

Description: Presented at October 2001 Annual Meeting. Discusses three key factors related to catastrophic health care events: • Trends in health care delivery and medical technology that are likely to impact catastrophic care costs • Methods of cost and risk control through early identification and specialized medical management • Modeling the cost of catastrophic events on health insurance programs

Description: This article explores the changing risk profile between the transitional Affordable Care Act (ACA) period (2014-2016) and under the final ACA period (beyond 2017) for the individual market. Actuaries are in a unique position to help facilitate the change from the current ACA period to the final period when health plans will have to take on substantially more risk.

Description: Presented at June 1996 Spring Meeting. A panel of experts discuss risk management and capital management issues for disability insurers and the potential role of reinsurance.

Description: Panelists discuss the role of the valuation actuary in health insurance. From the Record of the Society of Actuaries, Vol. 24, No. 2.

Description: This article talks about the challenges facing the FDA, especially those arising from the globalization of the pharmaceutical supply chain.

Description: A dicussion of the Rate Classification Actuarial Standard of Practice, ASOP #12: its purpose, its scope, guidance, and examples.

Description: This is the inventory part of the report from the research project that reviewed and inventoried the range of quality and efficiency measures currently available for healthcare. The goal was to outline key areas of quality and efficiency measurement and identify future opportunities for actuaries. The inventory lists the resources and provides brief descriptions of their services with links.