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  #91  
Old 07-12-2017, 04:33 PM
Wicked Actuary Wicked Actuary is offline
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For Seattle, does anyone have any thoughts as to why the EPO PEPM is really high as well? That can't be explained by the fact that most employees are on PPO. Plus, the EPO age/gender factor is slightly lower than average, so I don't think it works to say that this is due to an older population either. One idea I have is that because the PPO and EPO contributions are very similar, perhaps there is less anti-selection towards the PPO, and therefore the EPO plan has more higher-risk employees than normal? This is somewhat supported by the fact that chronic conditions are very similar between PPO and EPO. Also, the tobacco use is 8% higher for EPO than PPO; however, compared to the EPO national average (member-weighted), it is about average.

I'm also wondering if lower salary plays a role here too. How exactly might lower salary lead to higher claims? Is it that members would not utilize lower costing preventive treatment, which could lead to more expensive procedures in the future? According to the RAND study, this especially happens with a combination of low income + older population, but I suppose that low-income alone could cause it too. Even if this is the case, however, the average salary is only $6-7K below the national EPO average (member-wtd), so wouldn't we expect to see a similar phenomenon happening in other regions?

Thoughts?
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  #92  
Old 07-20-2017, 08:36 PM
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Sredni Vashtar Sredni Vashtar is offline
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I think the "Network Discount" is a big deal, although it's unclear to me exactly what it's supposed to mean. Is that supposed to be the whole price variance for similar procedures between networks, or is it just a rough indicator that BIG's network in Seattle sucks?

I think the "Other" Location may have its own reasons for being too low. Like being outside of a metropolitan area or something?

I don't remember the rand study, but most I've seen on preventative treatment is that it's a wash at best. But I'll have to look back...
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Last edited by Sredni Vashtar; 07-21-2017 at 09:00 AM..
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  #93  
Old 08-03-2017, 10:49 AM
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Sredni Vashtar Sredni Vashtar is offline
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Uhg. I do not like the answer to 2B. I didn't even address ideas given in the solution, because I thought they were really obviously wrong, based on the data.

To those reading. If like me, you had a lot of trouble coming up with a good answer, then make sure to at least talk about the simple, bad answers.

If you think it's not X, Y, and Z then say: "I don't think it's X because. I don't think it's Y because. I don't think it's Z because..."
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His enemies called for peace, but he brought them death.
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Last edited by Sredni Vashtar; 08-03-2017 at 10:53 AM..
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  #94  
Old 08-04-2017, 10:00 AM
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trondogss trondogss is offline
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Quote:
Originally Posted by Sredni Vashtar View Post
Uhg. I do not like the answer to 2B. I didn't even address ideas given in the solution, because I thought they were really obviously wrong, based on the data.

To those reading. If like me, you had a lot of trouble coming up with a good answer, then make sure to at least talk about the simple, bad answers.

If you think it's not X, Y, and Z then say: "I don't think it's X because. I don't think it's Y because. I don't think it's Z because..."
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Quote:
Originally Posted by Vomik View Post
You successfully played "just the tip?" Ive always ended up losing
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  #95  
Old 10-24-2017, 01:40 PM
lindsay538 lindsay538 is offline
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Quote:
Originally Posted by trondogss View Post
The top of the excel file says, "INCLUDE ONLY THIS TAB WITH EOM EXERCISE FOR THE CANDIDATE"

Do you think that means we can only submit the excel file with 1 tab? I did my analysis on a 2nd tab, and reference it in my memo. I noticed the note at the top when doing my final review.

I'm I gonna get dinged if I have my analysis on a 2nd tab? Thanks.
I have this same question. Anyone have any advice?
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  #96  
Old 01-05-2018, 12:11 AM
Brizzle Brizzle is offline
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Almost every post here that discusses any of the rates (a/g, chronic, etc) seems to imply that these rates are comparing ALL markets. i.e. people keep saying Seattle has a pretty low a/g factor.

I'm under the impression that these rates are just segmenting PPO/EPO in EACH market. It appears this way since the total between PPO/EPO is very nearly 1.0 in every market. So you can't say that Seattle has a healthy population from these. You can just say that the differential between PPO/EPO populations in Seattle isnt that large.

Does anyone else think this is a reasonable interpretation, or am I way off? It changes the answer to 2B a lot I think.
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  #97  
Old 04-29-2018, 11:54 PM
Brizzle Brizzle is offline
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Quote:
Originally Posted by Sredni Vashtar View Post
Uhg. I do not like the answer to 2B. I didn't even address ideas given in the solution, because I thought they were really obviously wrong, based on the data.

To those reading. If like me, you had a lot of trouble coming up with a good answer, then make sure to at least talk about the simple, bad answers.

If you think it's not X, Y, and Z then say: "I don't think it's X because. I don't think it's Y because. I don't think it's Z because..."
Do you mean if you think its not X, Y, or Z then say: It could be X because, it could be Y because, it could be Z because?

My solution actually normalized for a lot of the things suggested in the model solution and showed why those things aren't driving the problem. So then I suggested some alternative things that could be driving it.

This time around I am going to get rid of all of the work I did showing why its not X, Y, or Z and say "It could be X, it could be Y, it could be Z."
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