Description: This session from the 1995 SOA Boston Meeting presents the results of risk adjuster research in health care assessment and discusses the potential use of risk adjusters in health care reform efforts. From the Record of the Society of Actuaries, Vol. 21, No. 4b.

Description: 1994 SOA Meeting, San Antonio. This session on physician reimbursements focused on arrangements that might be offered by managed care companies, such as HMOs. It included an overview of key definitions, concepts, and incentive compensation arrangements.

Description: Panelists discuss the contractual relationships between health-care providers and health-care insurers [payers], and how they can be improved. Discussed are managed care, HMO, and PPO types of negotiated contracts in the private arena. Recent trends in types of provider arrangements, and expectations for the future, are also discussed. From the 2002 Record of Society of Actuaries, Volume 28, No. 3. Session 97PD of the Boston Annual Meeting.

Description: Presented at October 1986 Annual Meeting. This session discussion is highlighting recent developments in the Chicago health care delivery system, the involvement of Chicago area HMOs, PPOs and insurers in the financing and delivery of health care services, and issues unique to the Chicago market as well as issues applicable to other geographical areas.

Description: Changes introduced by various Medicare Alternative Payment Models and the Medicare Access and CHIP Reauthorization Act (MACRA) have accelerated an existing market trend of shifting some of what has traditionally been considered “insurance risk” to providers. The Provider Risk Sharing Boot Camp will give attendees deeper insights into methods, current thinking, and alternative solutions that actuaries can use to help providers understand and manage the financial and actuarial risks that they are taking, many for the first time.

Description: Presented at April 1986 Spring Meeting. Addresses costs, cost measurement and control, how target cost levels are established, and the cost/benefit perceptions of employers.

Description: Experts discuss new strategies related to provider contracting and network management. Topics include various reimbursement approaches and risk-sharing arrangements, unique risk arrangements for certain provider specialties, unique risk managements for specific diseases, and the role of care management/care coordinators. From the 2002 Record of Society of Actuaries, Volume 28, No. 2. Session 59PD of the San Francisco Spring Meeting.

Description: Panelists discuss HMO open access plans [in-network-only coverage, but no referral requirements] and the provider contracts and administrative systems that are needed to support them in a cost-effective way. From the Record of the Society of Actuaries, Vol. 25, No. 2.

Description: Panelists provide their perspectives on current issues in the dental market, such as: · Product development · Experience trends · Competitive marketplace · Future outlook From the Record of the Society of Actuaries, Volume 27, No. 1, Session 65

Description: This session from the 1984 SOA Atlanta Meeting covers cost containment in health care costs, cost sharing and cost containment features, underwriting, the use of deductibles or co-payments, different delivery systems and utilization.