Description: Synopsis of the report of the SOA Medical Effectiveness Task Force, which discusses the concept of health plan performance measurement and the contribution actuaries can make to this.

Description: This article compares three potential approaches to determining new coefficients for health-based risk scoring models: full recalibration, p-value credibility weighting, and penalized ridge regression.

Description: This session discussion is about pros and cons of the NAIC recommended rate filing guidelines, pros and cons of renewal rating practices of MET and individual major medical business. From Record of Society of Actuaries Vol. 16, No. 1.

Description: This session discusses various techniques for evaluating the success of an existing network as defined by profitability, risk exposure and long-term viability. Topics include network design, provider changes and quality measurement. From the Record of the Society of Actuaries, Volume 28, No. 2, Session 92

Description: Presented at September 1995 Valuation Actuary Symposium. Discusses the Health Organization Risk-Based Capital formula.

Description: Presented at April 1986 Spring Meeting. This session discussion is about what analysis is effective in measuring recent medical care experience and are the projected cost-containment savings presented to plan sponsors being realized.

Description: This article describes methodologies for detection and deterrence of Medicare fraud. It also describes the validation of PRIDIT for fraud detection in Medicare.

Description: Panelists lead participants in a discussion of recent experiences and current issues regarding the valuation of medical and dental insurance and managed care products. Topics include ASOP 22 [asset adequacy analysis for statements of actuarial opinion] and ASOP 41 [communication]. From the Record of the Society of Actuaries, Volume 29, No. 2, Session 102

Description: Presented at June 1996 Spring Meeting. This discussion looks at redirecting the traditional role of the actuary into new areas such as working with doctors to deal with medical management issues, dealing and negotiating with providers and how to help the company develop a provider payment strategy. Employers negotiating directly with providers is also discussed.

Description: Presented at October 2000 Annual Meeting. Discusses prescription cost trends, factors behind the trends, and cost management strategies for both the commercial and Medicare markets.