Description: This research report provides an evaluation and synthesis of the methodologies and data samples used on characterizing health care fraud.

Description: This session discussion is about methods of managing care, what methods have been most effective, experience to date under managed care products, are savings being generated, employer acceptance of managed care products, provider acceptance of managed care products, what will future managed care programs look like. Includes a discussion on utilization review and management, From Record of the Society of Actuaries 1988 Vol. 14, No. 1.

Description: This presentation from Session 86PD of the SOA 1996 Orlando Annual Meeting provides the physician perspective on ethical questions resulting from utilization review decisions infringing on physician decisions in providing health care. From the Record of the Society of Actuaries, Vol. 22, No. 3.

Description: Feature article discussing pending health care reform and the issue of access to care. From The Actuary Magazine, April/May 2010 Vol 7 Issue 2

Description: Physicians and hospital representatives will discuss their views on health care reform, insurance companies and managed care. From Record of Society of Actuaries Vol. 20, No. 3A.

Description: This session discusses affordable health care including cost drivers, trends, the uninsured, federal funding and state initiatives. From the Record of the Society of Actuaries, Volume 29, No. 2, Session 109

Description: The Society of Actuaries has developed and released a health care forecast model to illustrate the potential impact of the COVID-19 outbreak on insurance plan health care costs in the United States. Users of the model may include insurance company actuaries seeking an additional reference point for 2021 cost development, regulatory actuaries seeking additional insights and validation of costs as part of rating submissions for 2021, and insurance purchasers seeking a deeper understanding of the forces driving 2021 health care costs and premiums. The model is not intended as a replacement for existing modeling tools developed by insurers or regulators. Rather, the model’s primary purpose is to illustrate the key outbreak-related forces that are affecting the trajectory of health care costs. In addition the model can provide a common reference point to facilitate dialogue with respect to the regulatory review of 2021 health insurance rate filings.

Description: Panelists discuss major reforms of health care financing and delivery systems around the world. From the Record of the Society of Actuaries, Vol. 24, No. 2.

Description: This SOA report describes the components of margin for calculating capitation rates in a Medicaid context along with practical issues that MCOs may face.

Description: This article outlines what the author learned from the Sixth Annual Quality Colloquium at Harvard. From Health Watch, January 2008, Issue No. 57.