Description: This discussion looks at: what period or combination of periods could reliably be used for valuation purposes, if the practice of applying the rate of disability to mixed lives in the construction of monetary tables is appropriate, and problems from the use of the assumed date at commencement of disability as contrasted with the use of the date at the end of the waiting period.

Description: Summary of the health section council’s research project to assess the accuracy of commonly used IBNR estimation methods over a wide range of scenarios.

Description: Panelists discuss the history of this 75-year-old Medical Information Bureau MIB, its very active and data-rich source of medical information, and the services that the MIB offers to clients and other industry groups. From the Record of the Society of Actuaries, Vol. 24, No. 1.

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.

Description: Presented at September 1995 Valuation Actuary Symposium. Discusses the Health Organization Risk-Based Capital formula.

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: Presented at June 1996 Spring Meeting. This discussion looks at redirecting the traditional role of the actuary into new areas such as working with doctors to deal with medical management issues, dealing and negotiating with providers and how to help the company develop a provider payment strategy. Employers negotiating directly with providers is also discussed.

Description: Details of an actuary’s project to help a local nonprofit agency improve its data analysis and customer service issues.

Description: This article discusses the advantages, logistical concerns, and pricing formulas of implementing a TNHP, in which members pay less for treatment from providers who meet higher quality and cost-effectiveness standards.

Description: Panel discussion of alternative approaches to the design of reserve standards, to include those topics discussed in several recent papers and committee reports.