Care and Disease Management programs have grown to be a significant component of Managed Care in the U.S. and abroad. While much has been written on the clinical aspects of programs, this is the first textbook devoted to financial management and evaluation of healthcare intervention programs. It promises to become essential reading for those healthcare professionals interested in driving Return on their Investment in care management programs.
This text is now in the Course of Reading for SOA Fellowship study in the Group & Health specialty.
“Ian Duncan has written a timely and readable book on managing and evaluating the financial results of care management programs.
The tools and techniques he discusses are of interest beyond the actuarial world, and will be of great use to researchers and policy makers who want to understand if these programs actually work and their potential role in helping to control health care costs.
Anyone who reads Duncan’s book will be able to cut through the hype about care management in a more informed, objective and insightful way.”
Nancy Turnbull
Associate Dean for Educational Programs
Harvard School of Public Health
“Speaking as a non-actuary who is intimately involved in designing, conducting, and evaluating disease management programs and developing greater industry standardization of methods for such evaluations, I commend the authors for their thorough review of many of the more challenging methodological issues in determining disease and care management outcomes. I suspect that practicing actuaries and non-actuaries alike will find much in this book to refine their understanding and approach to evaluating and performing care management program outcomes assessments.”
Gordon Norman, MD, MBA
Executive Vice President, Chief Science Officer
Alere® Medical, Inc.
Author: Ian Duncan Mr. Duncan is president of Solucia Consulting, a SCIOinspire Company, provider of analytical and consulting services to the healthcare financing industry. Solucia consults on a wide range of issues in risk adjustment, predictive modeling and care management programs to health insurers, employers and state Medicaid plans. He has 30 years of experience in healthcare and insurance product design, management, financing, pricing, and delivery. He is frequent speaker about risk adjustment and predictive modeling.
Mr. Duncan holds a post-graduate degree in economics from Balliol College, Oxford, and is a Fellow of the Society of Actuaries. He serves on the boards of directors of the Commonwealth of Massachusetts Health Insurance Connector Authority and SynCare LLC. Academically, he is a member of the adjunct faculty at the Georgetown School of Healthcare Administration, and a Senior Scholar of the Department of Health Policy of the Thomas Jefferson Medical College.
Table Of Contents:
Part 1: An Introduction to Care Management Interventions
1. Introduction
2. Care Management and Interventions
3. Actuarial Issues in Care Management Evaluations
4. Estimating Savings, Utilization Rate Changes and Return on Investment - A Selective Review of the Literature on Program Evaluation
5. The Use of the Value Chain in Disease Management Program Planning
Part 2: Actuarial Issues in Care Management Interventions
6. Understanding the Economics of Disease Management Programs
7. Measuring Disease Management Savings Outcomes
8. An Actuarial Method for Evaluating Disease Management Outcomes
9. Understanding Patient Risk and its Impact on Chronic and Non-Chronic Member Trends
10. Random Fluctuations and Validity in Measuring Disease Management Effectiveness for Small Populations
Part 3: Practical Applications
11. A Comparative Analysis of Chronic and Non-Chronic Insured Commercial Member Cost Trends
12. Testing Actuarial Methods for Evaluating Disease Management Outcomes
Part 4: Wellness, Integrated Programs and other New Developments in Care Management Programs
13. An Introduction to Wellness and Integrated Programs
14. Evaluation of Work Site Wellness Programs - A Selective Review of the Literature
15. The Relationship Between Risk Factors and Health Care Claims Cost in Program Design and Evaluation