Description: Disease management [DM] is a health care intervention targeted to individuals with chronic diseases chronics. To justify the investment by payers in DM, it is important to demonstrate beneficial clinical and financial outcomes. This paper analyzes the health cost trends between the chronic and non-chronic populations. Paper 7 of an 8 paper series on 'An Introduction to Care Management Interventions and Their Implications for Actuaries'.

Description: This paper applies the principles and methodologies discussed in earlier papers in this series to measure cost savings from a two-year disease management DM program for the 200,000 Medicare members of a regional managed care plan. We then study how savings estimates change when we allow for four variations in key assumptions: methods for identifying or excluding plan members, requirements for eligibility in the health plan, methods for calculating health care trend and study design. Finally, we also examine the sensitivity of these results to product type by comparing the Medicare results to those of the Commercial HMO/POS product. Paper 8 of an 8 paper series titled: “Evaluating the Results of Care Management Interventions: Comparative Analysis of Different Outcomes Measures” sponsored by the Society of Actuaries’ Health Section and the Committee on Knowledge Extension Research.

Description: This paper describes an actuarial methodology for evaluating disease management outcomes. We address several important issues in this paper: • Control of exposure, • Identification of measured populations, and • Ensuring equivalence between baseline and intervention populations. - Paper 6 of an 8 paper series on 'An Introduction to Care Management Interventions and Their Implications for Actuaries'.