Description: The proposed session will introduce Outcome Based Risk Sharing Arrangements (“OBRSA”) between health insurance payers (“payers”, including insurance companies, health plans, sponsored employers, and government programs) and pharmaceutical manufacturers (“pharma”), and it’s intended to meet the needs of actuaries who focus on pharmacy benefits and risk sharing arrangements. The covered content will include (1) the background of OBRSAs, definitions, stakeholders, and OBRSA’s role in shifting the system from volume-based toward value-based; (2) conflicting perspectives about OBRSAs between payers and pharma (cultural and methodological); (3) identification of incentive gaps between payers and pharma, and incentive alignment between them; (4) barriers to implement OBRSAs; (5) limitations and considerations of OBRSA implementation; and (5) hypothetic OBRSA examples.

Description: Appendixes for the Evaluating ACO Efficiency: Risk Adjustment within Episodes study. The study aims to answer the question of how much of an episode’s cost and use of specific services can be attributed to the patient’s own health status, as opposed to being driven by other factors such as the care setting, patient preference, and provider practice patterns. In other words, do episode costs vary so widely because of patient characteristics, including health status, or are they related to other, nonclinical factors?

Description: This article is about environmental risk occupations, local environment and substance abuse and how they influence actuarial financial estimates. From The Actuary Vol. 24, No. 1

Description: In this, the second step, Sibson engaged the vendor and actuarial communities to solicit input on the actuarial model for determining the impact of various environmental, lifestyle and behavioral risk factors. The goal was to understand the extent to which actuaries currently use models around wellness, refine the above conceptual model, and better understand the potential uses of, and value to, the actuarial and vendor communities that would use such a model. We sought to understand the potential applications and sources of data for the actuarial model. We gathered input on how the model would best suit the professional needs and help shape the future role of the actuary. Lastly, we gathered feedback on the above conceptual model.

Description: This article is a review of another article that is an exposition of the mathematical methods used in the Framingham Study.

Description: The presenters will explore the roles of mental health and social determinants of health in the management of a population's total health. We will explore how emerging sources of data and information have led to a renewed focus on managing mental health conditions and social determinants of health. Speakers will address current health care programs that utilize this data and information to manage the total care for populations using predictive models to improve the deployment of resources and initiatives to improve the cost of care and health of populations. The presenters will also look at how providers of care are approaching mental health co-morbidities to manage physical health and social determinants of health in the management of patients.

Description: This report presents the results of a study comparing health risk scoring models.

Description: Presented at Living to 100 symposium, January 2011. Using longitudinal data from the Canadian National Population Health Survey, this paper seeks to identify social, behavioral and psycho-social factors associated with change in health status to provide insight for the aging baby boomers to help them foster a healthy aging experience.

Description: For the top-20 key risks, the carriers were asked to identify the key risk indicators (KRIs) they use for monitoring and the activities they use, or plan to use, to mitigate the likelihood of occurrence and/or the severity of impact.

Description: Med Supp