Description: Presented at June 1996 Spring Meeting. This discussion looks at redirecting the traditional role of the actuary into new areas such as working with doctors to deal with medical management issues, dealing and negotiating with providers and how to help the company develop a provider payment strategy. Employers negotiating directly with providers is also discussed.

Description: This presentation is a panel discussion, session 54PD, from the 2004 Spring Meeting of the Society of Actuaries, held June 14-15 in San Antonio, TX. This session covers the impact of segmentation and underwriting on expected mortality and morbidity. Panelists discuss the importance of data mining and customer selection on ultimate experience, setting up direct marketing applications with the right type of questions to maximize responses but limit risk, the use of prescription drugs and other databases, and industry practices for obtaining customer information. Discussion from participants is included. From the Record of Society of Actuaries, Volume 30, No. 2.

Description: Panelists discuss consumer-driven health plans [CDHPs]. Topics include pricing, large employer perspectives, and the overall impact on the marketplace. From Record of Society of Actuaries, Vol. 30, No. 1, Session 95

Description: Insurers are becoming increasingly involved in the development and marketing of prepaid health care service plans, or Health Maintenance Organizations HMOs. The article describes four different approaches for establishing capitation rates for HMOs 1. Integrated Budgeting Approach, 2. Inventory Approach, 3. Group Insurance Rating, and 4. Actuarial Approach.

Description: The article describes changes to the computation of discounted unpaid losses (claim reserves) as a result of the 2017 tax legislation.

Description: Actuaries should understand the economic considerations involved in the formulary drug decision-making process, and the presence of actuarial input in the process could improve it, especially by tying it to overall decision making for the health plan. From Prescription Drugs Monograph, M-HB04-1.

Description: Duncan's personal reflections on the state of care management evaluation.

Description: The ACA’s Medical Loss Ratio Provisions

Description: Introduction to the ACA @ 5 publication

Description: Discussion that developing credibility factors for group health insurance can be accomplished empirically through the use of stochastic models with appropriate parameters and fairly readily obtainable data, without the need for unrealistic assumptions.