Description: 1994 SOA Meeting, San Antonio. This session on physician reimbursements focused on arrangements that might be offered by managed care companies, such as HMOs. It included an overview of key definitions, concepts, and incentive compensation arrangements.

Description: This chapter focuses on creating practical models that aid in the prediction of the risk of readmission to a specific hospital within 30 days of discharge for Medicare patients, to aid in the identification and stratification of at-risk patients for hospitals considering building an intervention program in a cost-effective manner. For readers who wish to develop their own predictive model, a dataset is provided on the Actexmadriver.com website, and R code is provided in the appendix to this chapter.

Description: This model arose from a project to evaluate the cost of a health care access' program to provide comprehensive medical care to uninsureds in Minnesota, for the Minnesota Health Care Access Commission. The project was to provide estimates of the impact on per-person and aggregate costs for various participation percentages in the access program. In order to evaluate those costs, the antiselection model described in this was developed. Of note, this was the ACTUARIAL EDUCATION AND RESEARCH FUND 1991 PRACTITIONERS AWARD WINNER. From Actuarial Research Clearing House 1991, VOL. 2.

Description: 2004 SOA Spring Meeting, Anaheim, CA. In this session panelists presented an overview of underwriting processes for a variety of product lines. They also discuss related topics such as identifying keys to underwriting decisions, the cost of underwriting and protective value, and ensuring consistency with pricing assumptions. Some of the underwriting tools discussed were use of RX history, credit checks, DMV history, and fraud data bases.

Description: This paper addresses pricing stop loss insurance by employee for two benefits combined when the available information included a claims probability distribution for each benefit and the correlation coefficient between the benefits. From Actuarial Research Clearing House 1991, VOL. 1

Description: Article explores why many integrated delivery systems are struggling and what actions they need to take to succeed.

Description: 2021 ImpACT Conference - Session 4B: Post-COVID Strategies: Connecting Pandemic Outcomes, Health Equity and Fiscal Sustainability 10.26.21 Recording

Description: Large claims have always been a major source of volatility in health care claims experience. In this session, the presenters will discuss techniques for analyzing large claims, predicting large claims and measuring the associated risk. The presenters will also discuss the early results of the SOA 5/50 research project which will examine the 5% of the population that accounts for 50% of the health care costs.

Description: 2003 Valuation Actuary Symposium, San Diego, CA. The panel discussed the current challenges in the health reinsurance marketplace. Topics included traditional quota share reinsurance, employer and provider stop-loss coverage, difficulties in obtaining reliable and credible data from a ceding carrier and terrorism reinsurance.

Description: 1993 SOA Spring Meeting, San Diego. This session is about point-of-service plans, overview of current enrollment statistics/ tends, in-network and out network utilization patterns, trends in benefit design, employer/benefit consulting demands and employee/employer satisfaction.