Description: A summary of Medicare reform and its effect on prescription drug coverage.

Description: This article discusses health care reform in Kentucky. In 1994, Kentucky implemented health care reform measures inspired by the unsuccessful attempt at national health care reform in the Health Security Act of 1993. The measures adopted in Kentucky are described by the author as 'a textbook case of how not to engage in health care reform.' From: The Actuary, April 2000 – volume 34 - Issue 4.

Description: Two Medicare risk funding provisions that were radically changed by the BBA of 1997 funding variations by geographic area and risk adjustment. Issue No. 36

Description: This 1991 panel discussion is about delivering adequate universal health coverage. The panelists discuss the Canadian national health care system, Oregon's plan to seek a Medicaid waiver to implement a new format within which health care will be reimbursed, and the American Medical Association's [AMA's] Health Access America reform proposal. From the Record of the Society of Actuaries Vol. 17, No. 4A.

Description: 2001 SOA Annual Meeting, New Orleans. Health care cost trends have substantially increased in the past two years. Panelists discussed the factors contributing to these increased trends, the prospect for further increases in the future, and national health care issues.

Description: Panelists discuss major reforms of health care financing and delivery systems around the world. From the Record of the Society of Actuaries, Vol. 24, No. 2.

Description: Essay reforming management in health care, structure of reimbursement, program management, health information, measurement systems, etc.

Description: Essay discussing that the two factors that affect healthcare cost are costs and the fact that people lack coverage.

Description: This session explores the far-reaching changes to how clinical data will be sourced, processed and consumed in many payer use cases including risk adjustment, quality measurement, care management, claims adjudication, prior authorizations, and other payer functions. Robust, interoperable data exchange is a prerequisite for value-based care. Clinical data will be increasingly accessible to augment administrative (claims) data via standardized Fast Health Interoperability Resources (FHIR, pronounced 'fire'), at a fraction of the cost of a accessing a traditional medical record and in real-time. On May 1, 2020, HHS issued a final rule implementing interoperability and the patient access provisions of the 21st Century Cures Act of 2016, although enforcement has been delayed into 2021 because of the COVID-19 pandemic. The new regulations promote, “HHS’s vision and strategy for achieving a health information ecosystem within which all individuals, their personal representatives, their health care providers, and their payers are able to send, receive, find, and use electronic health information in a manner that is appropriate, secure, timely, and reliable to support the health and wellness of individuals through informed, shared decision-making, as well as to support consumer choice of payers and providers.”Once enforcement begins, CMS and the Office of the National Coordinator for Health Information Technology (ONC), have the authority to mandate adoption of interoperability requirements, and also penalize payers and providers for non-compliance or the delay and withholding of data.This ‘digital transformation’ of the clinical data ecosystem has far-reaching implications for enabling technologies including Natural Language Processing (NLP) and entire segments of services and vendors. It will eliminate many departmental barriers, duplication and error sources for health plans and impact every department and the underlying economics of delivering and managing care.

Description: Successful healthcare reform: First, it must help that must keep healthy people healthy. Second, it must help people mitigate or eliminate the health-risks associated with unhealthy lifestyle behavior choices, and Third, it must ensure the provision of evidence-based care to those who are ill.