Description: By rationing heath care resources, managed-care organizations have raised ethical and legal issues not commonly found under previous health-care-financing structures. Panelists, including a member of the Board and the Executive Committee of the American Medical Association [AMA], and the audience debate this issue. From the 1997 Record of Society of Actuaries, Vol. 23, No. 3.

Description: Panelists discuss employers' perspective of defining strategies to identify best-in-market opportunities. From the Record of the Society of Actuaries, Vol. 24, No. 1.

Description: Research project that reviewed and inventoried the range of quality and efficiency measures that demonstrate the performance of hospitals and physicians. Besides outlining key areas of consideration for quality and efficiency measurement, this report also describes future opportunities for actuaries and other health professionals interested in this evolving area. The inventory part of this report is in a separate document.

Description: A proposal to address provider payment issues by gradually moving to accountable care organizations. Capitations would be risk-adjusted, non-capitated costs would be covered by hospitalization fund and stoploss, incentives for quality & effective preventive care would be tied to the amount remaining in the fund, and government involvement would be through incentives rather than mandate.

Description: This article talks about the new onsite clinic at Hewitt and how it benefits employees and employers.

Description: Read the March 2017 issue of Health Watch, published by the Health Section. Practical information for actuaries, articles impact sections, section activities.

Description: Medicaid and the ACA

Description: A rethinking of current provider reimbursement, focusing on incentives instead of simply cutting fees. The recommended 2-pronged approach would feature integrated provider organizations as well as evidence-based decision making organized around episodes of care.

Description: Part 1 of a 2-part series exploring implementation issues for the Mental Health Parity and Addiction Equity Act of 2008 MHPAEA. Part 2 addresses the new enforcement safe harbor, how the regulations could impact the business of behavioral health care and the impending decisions for payors, employers, providers, and insureds.

Description: The ACA’s Medical Loss Ratio Provisions