Description: Summary of the National Conference on Group Practice of Medicine, held in Chicago from October 19-21, 1967 to explore means for stimulating the group practice of medicine.

Description: There is a wide range of literature on aging and health care. We sample this literature and find it fits into the subcategories of theoretical aging, medical significance of aging, treatment of the elderly, and resource allocation to the elderly. Themes are that financial arrangements can cause inefficient and ineffective care and that care guidelines need to developed specifically for the elderly rather than extrapolating guidelines for younger patients.

Description: Beginning with the 2019 Benefit Year, CMS (the Centers for Medicare and Medicaid Services) has provided guidance that allows Medicare Advantage Plan Sponsors much greater flexibility in tailoring benefits to promote clinical, care management, and financial goals. The guidance allows for a broader menu of supplemental benefits and also enables plans to target benefit enhancements to beneficiaries afflicted with specific disease states. This session explores the ramifications of the policy changes on Plan Sponsors and beneficiaries, and discusses the different ways that Plan Sponsors are taking advantage of the additional flexibility.

Description: MHPAEA prohibits health plans from imposing financial requirements or treatment limitations on behavioral health benefits that are more restrictive than those applied to medical and surgical benefits. MHPAEA's regulations define treatment limitations to include nonquantitative treatment limitations (NQTLs), which are benefit design features that are not numerical, but otherwise limit the scope or duration of benefits.

Description: HIV is still a big public health concern, but there are therapies available to prevent infection before and immediately after exposure. As legislatures and the USPSTF considers adding these therapies to the list of preventive care covered without cost share, actuaries will need to estimate the impact on their care cost. The presenters will share an actuarial tool kit to estimate the impact of covering PrEP and PEP for different populations. Examples are provided and discussion is welcome.

Description: This article is about the growth of health actuaries and new opportunities in light of the Health Insurance Portability and Accountability Act of 1996 and the Balanced Budget Amendment of 1997.

Description: This presentation from Session 61PD of the SOA 1996 Orlando Annual Meeting provides an update on changes to the Medicare health program over the last couple years. In addition, the panelists discuss the merits of additional proposed changes from the White House and both sides of the aisle in Congress. From the Record of the Society of Actuaries, Vol. 22, No. 3.

Description: Panelists discuss the future of prospective payment in Medicare, sequels to the Omnibus Budget Reconciliation Act, the Deficit Reduction Act, COBRA, fallout from the administration's Catastrophic Illness Study, and the evolution of the voucher proposal. From the 1987 Record of Society of Actuaries, Vol. 13, No. 1.

Description: A proposal to reform current health care market, from a 'preferred payer' system, in which Medicare and Medicaid pay less than the true cost while others must then pay more, to a 'value for money' system. This would be achieved by requiring providers to bill all patients the same rate for the same services, with a standard bundling format to make all providers' rate differences transparent. Differences between billed charges and what Medicare pays would be made up by the Medicare patient, rather than subsidized by those outside of Medicare.

Description: Prescribers, payers, and patients must put a higher priority on the comparative cost-effectiveness of competing pharmaceutical products if society is ever going to achieve rational and affordable drug use for all. From Prescription Drugs Monograph, M-HB04-1.