Description: This session will discuss the continuing evolution of the managed health care process. Topics include precertification, utilization review, retrospective review, case management, appropriateness review, benchmarking, recredentialing, provider contracting, and integrated medical systems. From Record of Society of Actuaries Vol. 20, No. 3A.

Description: This panel discussion presented at the 1980 SOA Spring Meeting in Minneapolis discussed competition in health care delivery from the perspective of what was happening in Minnesota, a key HMO state. From Record of Society of Actuaries, Vol. 6, No. 2.

Description: This analysis provides an overview of the functional components of the managed care system. It discusses the market forces underlying the United States’ system for health care financing and delivery and suggests how market forces impact the health care industry. The analysis focuses on societal goals for health care delivery and on managed care’s effectiveness in enabling achievement of those goals. The analysis develops and uses an innovative model developed to summarize the complex interplay among the many stakeholders, or participants, in the health care system. The model provides a framework for analysis of the many relationships among stakeholders. The analysis also highlights current issues in managed care, particularly the barriers that impede collaboration among stakeholders.

Description: The medical and behavioral health care provider communities have long debated whether high-quality behavioral health care reduces medical costs. This presentation from Session 85PD of the SOA 1996 Colorado Springs Meeting reviews past studies relating to medical cost offsets and explores the potential magnitude of such design and delivery of medical and behavioral health care programs to encourage potential health care cost savings and to increase wellness. From the Record of the Society of Actuaries, Vol. 22, No. 2.

Description: CHCS is a nonprofit policy center focused on improving American health outcomes, particularly for low-income people, including payment & delivery system reform.

Description: Since health care reform has made accountable care organizations a hot topic, an SOA workgroup is addressing relevant questions, including provider risk under various ACO models, limitations of the Medicare model for motivating change in the health care delivery system, strategic priorities, attribution of members, meaurement, and the roles actuaries can play.

Description: Medical insurance today is more like pre-paid medical payments. Medical insurance should be bought for protection, but rarely used, like auto insurance.

Description: This session discusses rising health care costs and availability of coverage. From Record of the Society of Actuaries 1982, Volume 8, No. 1.

Description: Considerations in the applications of Predictive Modeling for health care management. Issue No. 47.

Description: This session features a moderated discussion between medical professionals who are experts in long-term care. The presenters are outside the LTC insurance industry altogether, which will ensure that attendees receive a truly external perspective.