Description: This session at a SOA 1990 Spring Meeting is about open ended managed care plans from various perspectives including structure, marketing and actuarial issues.

Description: Methods and assumptions used in the valuation of savings by external care vendors

Description: Through the sponsorship of the Robert Wood Johnson Foundation, The Society of Actuaries partnered with Wakely to use their health care data to study the effects of COVID-19 on overall health care claims for individuals with a COVID-19 diagnosis. The conclusion of the study is that individuals with COVID-19 claims had significant increases in health care costs leading up to their months of diagnosis, as well as in the months following their diagnosis. These effects were more pronounced for individuals who were hospitalized due to COVID-19 as well as for individuals with prior co-morbidities. Finally, the overall health care costs of these members plateaued at significantly higher levels than their pre-COVID baselines. In fact, all the main membership cohorts experienced claim levels that were at least 20% higher than their pre-COVID starting points.

Description: This research report provides an evaluation and synthesis of the methodologies and data samples used on characterizing health care fraud.

Description: Provides an overview of a Columbia University graduate course in actuarial science called a Global Perspective of the Health Insurance Market. It includes an overview of this unique course and a summary of course content and completed research in the course. The course covers all financial aspects of US and international health insurance.

Description: This session will explore the national landscape of state Medicaid risk adjustment program design & application and the key differences that drive effective managed care organization program management. Risk adjustment is a mechanism to adjust capitation rates between Managed Care Organizations to account for population morbidity differences. Although many states utilize this mechanism, the application of risk adjustment can vary significantly across states. The primary differences include populations, risk score models and data collection. These state application nuances affect the strategies and tactics utilized by MCOs for effective risk adjustment program management including provider financial alignment, encounter data submission and the capture of accurate diagnosis codes. The session is intended for Medicaid Managed Care Actuaries working to develop or support comprehensive risk adjustment program management functions.

Description: This is a panel discussion about the future of health care and health care insurance. From Transactions of Society of Actuaries 1968, Vol. 20 Pt. 2, No. 58

Description: This session discussion is about two proposals for health-care reform will be presented, one from the Blue Cross/Blue Shield Association and one from the Council for Affordable Health Care. These dramatically different proposals will be compared and open for critique. From Record of Society of Actuaries Vol. 18, No. 4A.

Description: This session discusses the impact of rising costs and increased litigation on managed care. From the Record of the Society of Actuaries, Volume 27, No. 1, Session 133