Description: Twenty years ago Steve Tutewohl’s clients were taking bold risks with limited information, little analytical support and hardly any data. As an actuary working on the provider side, Tutewohl started out in a traditional role in an untraditional environment. In his early years at Valence Health he was focused on educating, informing and bringing knowledge to providers so they could level the playing field with payers when they were negotiating and managing risks. Today Tutewohl’s clients have “data that is above and beyond what the payer has.”

Description: Panelists discuss issues arising from the Health Insurance Portability and Accountability Act of 1996. From the Record of the Society of Actuaries, Vol. 24, No. 1.

Description: This presentation is a Health Section meeting from the 1991 Annual Meeting of the Society of Actuaries, held October 20-23 in Toronto. The session leader, the incoming chair of the section, covers administrative matters, and then the next speaker addresses a newly completed research project, sponsored by the Society and Health Section, on the variation by duration in small group medical insurance claim costs. The speakers then discuss current developments in small group reform, and the various parties involved, including the National Association of Insurance Commissioners [NAIC], and the Health Insurance Association of America [HIAA], and the work that has been done, including modeling to address the impact of a small group reform mechanism. The speakers discuss how the various parties' objectives can differ. Discussion from participants is included. From the Record of Society of Actuaries, Volume 17, No. 4B.

Description: The SOA released a report titled Massachusetts Health Insurance Reform, which looks at the impact on insurance markets, pricing and profitability.

Description: The purpose of this SOA-sponsored research was to assemble and analyze a limited large claims database which may serve as a model for expanded inter-company studies of health care benefits in the future. From Group Medical Insurance Large Claims Database Collection and Analysis, M-HB97-1.

Description: Panelists discuss the pros and cons of using a care manager in order to receive either benefits or enhanced benefits in long term care plans. From the Record of the Society of Actuaries, Vol. 24, No. 2.

Description: This session discussion is about hospital strategies in delivering and financing care, physician reaction to current market, physician strategies in delivering and financing care, and provider reaction to managed care programs. From Record of the Society of Actuaries 1987 Vol. 13, No. 1.

Description: Panelists discuss the methods HMOs employ to measure their providers' quality of care, outcomes, compliance with best practice guidelines, and cost control. From the Record of the Society of Actuaries, Vol. 25, No. 2.

Description: This study was sponsored by the Society of Actuaries Health Section. This paper explores the relative significance of aging as a determinant of financial cost of health care beyond age 50, with particular attention to the effect for ages 65 and older. The paper presents concepts of aging factors and aging curves, which define relative values between ages for utilization or cost of health care services. General conclusions are drawn from Medicare data that utilization and cost differ by age, but that aging factors vary across services and may be less significant at very old ages. The author then turns to the question of measuring the significance of an aging curve assumption and what accuracy is lost in the simpler alternative of a single value across an age range.

Description: An economic analysis of bariatric surgery and health care costs supports the case for health plans to cover these procedures.