Description: This 1992 discussion is about the resource-based relative value scale [RBRVS]- where it is and where it's going, and its impact on trends, Medicare supplemental coverage, indemnity plans, and health cost projections. From the Record of the Society of Actuaries Vol. 18, No. 1A.

Description: This session will explore the national landscape of state Medicaid risk adjustment program design & application and the key differences that drive effective managed care organization program management. Risk adjustment is a mechanism to adjust capitation rates between Managed Care Organizations to account for population morbidity differences. Although many states utilize this mechanism, the application of risk adjustment can vary significantly across states. The primary differences include populations, risk score models and data collection. These state application nuances affect the strategies and tactics utilized by MCOs for effective risk adjustment program management including provider financial alignment, encounter data submission and the capture of accurate diagnosis codes. The session is intended for Medicaid Managed Care Actuaries working to develop or support comprehensive risk adjustment program management functions.

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.

Description: The last three decades have witnessed an important rise in number of people with diabetes in Asia, especially Type 2 Diabetes. Like no other common condition, numerous innovations are currently entering the healthcare system that will soon have a significant impact on management of the condition. This presentation explores the role played by sensors/wearables, artificial intelligence, new drugs and diabetes apps. We assess the realistic potential of such advancements and give an outlook on medium-term pricing and product development.

Description: This 1991 open forum discussion is about the resource-based relative value scale [RBRVS] and its impact on physician fee trends [Medicare and non-Medicare], physician specialization, utilization, Medicare supplement plans, employer plans [active and retired], HMOs, and physicians and senior citizens. From the Record of the Society of Actuaries Vol. 17, No. 3A.

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: 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: Presented at June 1986 Spring Meeting. This session discussion is about the status of state and federal regulations regarding the development of PPOs and other alternate delivery systems and anti-trust laws affecting PPO development.

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: The presenters will provide insights into fraud and abuse risk in the health insurance industry, including an examination of traditional and predictive modeling techniques for both prevention and detection. Emphasis will be placed on current and emerging risks. Canadian examples and perspectives will be offered, but the applications for attendees to use in practice are non-nation specific.