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: 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 session takes a fresh look at the issues related to acute care focus and the challenges of providing coordinated care for chronic conditions in the United States. From the Record of the Society of Actuaries Vol. 31 No. 2, Session 80

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

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'.

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: 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: Summary of cost-reduction and quality improvement within the disease management sector. Paper 4 of an 8 paper series on 'An Introduction to Care Management Interventions and Their Implications for Actuaries'.

Description: This session discusses disease management [DM] and the role of health actuaries versus economists and biostatisticians. Topics discussed include economics of DM, epidemiology strategies, and operational concerns. From the Record of the Society of Actuaries, Volume 29, No. 2, Session 21pd.

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.