Description: This session discussion legal liability for unfavorable medical outcomes, effect of utilization review on the quality of care and patient/provider acceptance, protocol development and implementation for managed care, and insurance coverage necessary to protect your organization. From Record of the Society of Actuaries 1987 Vol. 13, No. 1.

Description: The article gives actuaries an introduction to Academy Health, the notable health policy research organization.

Description: This paper discussed providing consumers of medical care with transparent and comparable price and quality information to enable them to make economically optimal decisions.

Description: Paper summarizes articles on quality care issues including - measurement & reporting, financing, patient safety, standards & education, and leadership.

Description: In this era of rising health care costs, numerous efforts have been made to link quality and cost through multiple approaches. This is a report of a study, conducted by MPRO under contract with the SOA, in which they evaluate whether quality pays or not in an inpatient setting by carefully selecting a few hospitals in Southeast Michigan and retrospectively calculating their return on investment [ROI] in quality improvement [QI] activities within their organization.

Description: By rationing heath care resources, managed-care organizations have raised ethical and legal issues not commonly found under previous health-care-financing structures. Panelists, including a member of the Board and the Executive Committee of the American Medical Association [AMA], and the audience debate this issue. From the 1997 Record of Society of Actuaries, Vol. 23, No. 3.

Description: In this paper, we shine a light on the global public health epidemic of intimate partner violence (IPV). This first paper presents background information on the problem with a focus on health and economic impacts for the actuarial audience

Description: Part 1 of a 2-part series exploring implementation issues for the Mental Health Parity and Addiction Equity Act of 2008 MHPAEA. Part 2 addresses the new enforcement safe harbor, how the regulations could impact the business of behavioral health care and the impending decisions for payors, employers, providers, and insureds.

Description: The MACRA/QPP Provider Revenue Model is designed to provide an estimate of the revenue impact of the QPP (MIPS, AAPM) on a provider group or ACO, based on the required inputs and scenarios.

Description: The MACRA/QPP Payer Revenue Model is designed to provide Health Plans an estimate of the expected claim cost increase/decrease due to MACRA.