Description: Panelists discuss the various managed-care alternatives as well as ways to evaluate their effectiveness. From the 1988 Record of Society of Actuaries, Vol. 14, No. 4A.

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: The measure of a health-care provider's quality and efficiency can be used to reward or penalize the provider through reimbursement strategies and plan designs. Panelists discuss the measures that are becoming available. From the 2002 Record of Society of Actuaries, Volume 28, No. 2. Session 24PD of the San Francisco Spring Meeting.

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: This session will teach the ABCs of HMOs and PHOs. Topics include provider networks, contracting, utilization controls, integrated health care, From Record of Society of Actuaries Vol. 20, No. 3A.

Description: Presented at September 1995 Valuation Actuary Symposium. Discusses the Health Organization Risk-Based Capital formula.

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 session discusses HMOs: do they manage health better, do provider financial incentives reduce quality, do HMOs profit from shadow pricing, and do they attract better risk. From Record of Society of Actuaries Vol. 16, No. 1.

Description: Panelists discuss the various types of risks in health insurance and health-care delivery, and various types of risk-absorption mechanisms for sharing these risks among providers, insurers, employers, and employees. In addition, they address the management of the risk from a corporate perspective, which will include bottom-line earnings and marketing goals and objectives. From the 1987 Record of Society of Actuaries, Vol. 13, No. 4B.

Description: Discusses health-care-cost reimbursement structures, from the facility/hospital perspective and the professional/doctor perspective. Also discusses risk-absorption methods. From the 1987 Record of Society of Actuaries, Vol. 13, No. 1.