Description: This article is directed to the payors—especially self-funded employers and TPAs—that seek to improve the health of the populations they cover in addition to administering the plan. Greater use of primary care is one way to better manage the health delivery. The results should also impact costs in a measurable way. Issue No. 59

Description: Article describes enhanced primary care models and provides citations on whether or not health care savings have been achieved.

Description: Actuaries are currently familiar with the impact of new technologies used primarily by clinicians and health care providers, such as new drugs and devices. The common theme emerging from many of the articles points to a technological revolution in health care accelerated by the COVID-19 crisis this year. Actuaries need to understand these technologies, their impact, learn how to drive this technological change and guide the response of their profession and their own health care organizations.

Description: This article examines the costs of mental health parity, presents the primary drivers of cost increases from legislation and shows evidence the initial cost projections were too high. From Health Section News, March 2005, Issue No. 49.

Description: This article reviews the cost of behavioral health care and looks at how the involvement of Primary Care Physicians leads to a less efficient and effective treatment and is an increasing cost many plans have yet to address. From Health Section Newsletter, March 2005, Issue No. 49.

Description: Health Watch Newsletter, May 2006, Issue No. 52. This article presents information from a recently completed client-sponsored survey of hospital contracting best practices. Individual health plans were evaluated using a structured survey document. The primary objective of the survey was to identify best practices that the client sponsor could implement to improve its already better-than-average hospital contracting practices

Description: As actuaries in health care, we spend most of our time focused on reviewing claims, enrollment and clinical data. That information is captured while patients are in health care facilities. Yet most people spend only a small fraction of their time in these facilities. This article explores what types of data are available to actuaries the provide a more holistic view of the member so that a members physical and emotional needs, the social determinants of health can be taken into consideration along with their clinical needs. Two uses cases are presented so actuaries can see how these types of analyses can be leveraged to improve clinical, operational, and financial performance of risk bearing health entities. Understanding the customer (member) not just the patient enables actuaries to provide new insights and values to our stakeholders across a wide range of business and risk applications.

Description: Implications of Consumer-Driven Health Care to consumers, employers and providers Issue No. 37.

Description: Methods and assumptions used in the valuation of savings by external care vendors

Description: Discussion of Alternative or Integrative Care - Fundamental themes, market demand, recent activity, developing an alternative care program, pricing benefits Issue No. 34.