Description: 1994 SOA Meeting, San Antonio. This session was about provider network building in nonmetropolitan areas. Question addressed: 1. How can an effective delivery system be built to serve rural areas? 2. What influence will health care reform have on such systems? 3. Does a single-payer system make sense for such populations? 4. How does health care reform impact nonmetropolitan markets?

Description: This article describes Medicare Supplement and short-term care products in more detail, and we compare their risk profiles. We explore the concept that these two products—when offered together—may provide a complementary hedge of certain policyholder behavior risks.

Description: This paper provides a method for estimating long-tailed unpaid losses from paid loss development using trended generalized bondy development. From Actuarial Research Clearing House 1993, VOL. 3.

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: 1994 SOA Meeting, San Antonio. This session on physician reimbursements focused on arrangements that might be offered by managed care companies, such as HMOs. It included an overview of key definitions, concepts, and incentive compensation arrangements.

Description: This chapter focuses on creating practical models that aid in the prediction of the risk of readmission to a specific hospital within 30 days of discharge for Medicare patients, to aid in the identification and stratification of at-risk patients for hospitals considering building an intervention program in a cost-effective manner. For readers who wish to develop their own predictive model, a dataset is provided on the Actexmadriver.com website, and R code is provided in the appendix to this chapter.

Description: This paper addresses pricing stop loss insurance by employee for two benefits combined when the available information included a claims probability distribution for each benefit and the correlation coefficient between the benefits. From Actuarial Research Clearing House 1991, VOL. 1

Description: 2003 Valuation Actuary Symposium, San Diego, CA. The panel discussed the current challenges in the health reinsurance marketplace. Topics included traditional quota share reinsurance, employer and provider stop-loss coverage, difficulties in obtaining reliable and credible data from a ceding carrier and terrorism reinsurance.

Description: 1993 SOA Spring Meeting, San Diego. This session is about point-of-service plans, overview of current enrollment statistics/ tends, in-network and out network utilization patterns, trends in benefit design, employer/benefit consulting demands and employee/employer satisfaction.

Description: This article describes the four keys to successful worksite marketing: 1. Onsite selling either with group meetings or one-on one using professional enrollers. 2. Use a process that has been proven successful. 3. Gain employer sponsorship/commitment/endorsement. 4. Ensure your insurance company is committed as evidenced by high quality service from issue on through the life cycle of the policy.