Description: Report from 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 the report is in a separate document.

Description: Panelists discuss different aspects of self-selection among Medicare options. From the Record of the Society of Actuaries, Vol. 24, No. 2.

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: Discussion of the economics of a possible H5N1 pandemic, and its impact on Life, Health, and Property and Casualty insurers, in terms of areas of risk, especially underwritng risk, operations risk, and market risk.

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: Article suggests future steps with regard to this project and provides information on where to get the essays.

Description: Restoration of Benefits ROB: the provision of a long-term care policy that allows policyholders to restore their maximum benefit period after they have used some or nearly all of their policy benefits to pay for a covered claim event. This is a provision that should be managed closely.

Description: Sponsors of DB plans are being forced to focus on their plans as never before. A confluence of events—market downturn, aging workforce and changing legislation/regulation—has meant the status quo no longer applies to companies’ DB plans.

Description: Defines and discusses operational risk as it exists in every industry, especially as it exists in the financial services industry.