Description: A proposal to address provider payment issues by gradually moving to accountable care organizations. Capitations would be risk-adjusted, non-capitated costs would be covered by hospitalization fund and stoploss, incentives for quality & effective preventive care would be tied to the amount remaining in the fund, and government involvement would be through incentives rather than mandate.

Description: This article discusses new opportunities for states to waive certain marketplace requirements of the Patient Protection and Affordable Care Act. The article focuses on specific opportunities for states and the role that actuaries will play.

Description: Presented at April 1985 Spring Meeting. Addresses questions being asked about the future of health care financing: 1. Will the traditional insurer-based program be the predominant financing mechanism in the future? 2. Will Preferred Provider Organizations, Health Maintenance Organizations or other mechanisms displace current approaches? What additional institutions will enter this field? 3. What major factors will determine the outcome?

Description: As providers are considering accountable and value based care models, it is critical to strategically think through how to achieve a sustainable business model into the future. This requires actuarial and clinical/provider capabilities to assess the care management and financial levers to help a client through the transition.

Description: Presented at October 1986 Annual Meeting. Discussion covers: how hospitals and hospital management companies are increasingly entering traditional indemnity insurance markets, hospital representatives address health care financing from the hospital perspective, the risks and financial incentives from the hospital's perspective, and whether hospitals are marginally pricing their health insurance products.

Description: Explanation of Medicare Advantage STAR rating program as it relates to payment rates for MA bids. Also describes important features of the program from an actuarial perspective, how the components of the STAR rating are calculated and implications and considerations for actuaries.

Description: Presented at October 1986 Annual Meeting. This session discussion is about joint ventures between Health Maintenance Organizations 'HMOs' and insurance companies, dual or triple option rating strategies, how these ventures are structured from a financial standpoint, and how separate organizational objectives are met.

Description: Presented at June 1996 Spring Meeting. This is a discussion on how to decide whether to build a network or develop an alliance with an integrated delivery system.