Description: Panelists discuss their research study into actuarial issues stemming from care and disease management programs. Topics include programs, interventions, and measuring outcomes. From the Record of the Society of Actuaries, Vol. 31, No. 2, Session 31

Description: What’s New in Disease Management Medicare Modernization Act, certification of DM outcomes, DM publications. Issue No. 48

Description: This paper describes seven methods used in care management in the order of their historical development: 1. Pre-Authorization 2. Concurrent Review 3. Case Management 4. Demand Management 5. Disease Management 6. Specialty Case Management 7. Population Health Management Paper 1 of a 8 paper series

Description: This is one of a series of SOA-sponsored papers on the subject of Evaluating the Results of Care Management Interventions. This paper addresses the theory of measurement design and provides a practical evaluation of the most common designs for the practitioner.

Description: A review of literature regarding care management program outcomes - either financial or utilization-related which are indicative of financial improvement or from which financial conclusions may be drawn. Includes a discussion on utilization & concurrent review, case & demand & population & disease management . Paper 3 of an 8 paper series on 'An Introduction to Care Management Interventions and Their Implications for Actuaries'.

Description: Projecting start-up capital requirements for Health care co-ops and public plans

Description: Report from research project that reviewed and inventoried the range of quality and efficiency measures that demonstrate the performance of hospitals and physicians. Besides outlining key areas of consideration for quality and efficiency measurement, this report also describes future opportunities for actuaries and other health professionals interested in this evolving area. The inventory part of the report is in a separate document.

Description: This is an article about population risk management and using it to reduce health insurance costs.

Description: Actuaries are increasingly being called upon to advise management about the value of medical management programs and interventions. This session discusses disease management outcome measurements and the cost vs value issues. From the Record of the Society of Actuaries, Volume 30, No. 1, Session 111

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.