Description: This article describes methodologies for detection and deterrence of Medicare fraud. It also describes the validation of PRIDIT for fraud detection in Medicare.

Description: A call for essays issued by the SOA Health and Long Term Care Sections on the visions for the future of the U.S. health care system.

Description: Essay reforming healthcare where participants have a vested interest in reaching the best answer.

Description: Essay reforming management in health care, structure of reimbursement, program management, health information, measurement systems, etc.

Description: Employer and payers need to actively seek change in the system of mental health care deliveryoperational, clinical, and financial change. From Financing Chronic Care Monograph, M-HB05-1.

Description: Disease management DM is increasingly encountered in health plans and employer groups as a health care intervention targeted to individuals with chronic diseases chronics. The untested assumption is that without DM, the chronic and non-chronic trends are identical. From Financing Chronic Care Monograph, M-HB05-1.

Description: Essay where payers desiring to optimize health gains per dollar spent should avoid “across the board” cost sharing, and instead implement a “value based” design that removes barriers/provides incentives to encourage desired behaviors for patients and providers.

Description: Presented at May 2000 Spring Meeting. Discusses common problems in creating a successful merger - such as not incorporating community support, and not achieving economies of scale - and how to avoid them.

Description: Since health care reform has made accountable care organizations a hot topic, an SOA workgroup is addressing relevant questions, including provider risk under various ACO models, limitations of the Medicare model for motivating change in the health care delivery system, strategic priorities, attribution of members, meaurement, and the roles actuaries can play.