Actuarial Outpost
 
Go Back   Actuarial Outpost > Exams - Please Limit Discussion to Exam-Related Topics > SoA > Fellowship Modules > Financial Economics
FlashChat Actuarial Discussion Preliminary Exams CAS/SOA Exams Cyberchat Around the World Suggestions



Reply
 
Thread Tools Search this Thread Display Modes
  #41  
Old 05-22-2012, 09:46 AM
moniccazz moniccazz is offline
Member
SOA AAA
 
Join Date: Aug 2005
Location: NYC
Studying for CE credits
College: Wisconsin
Favorite beer: BEER
Posts: 501
Default

i feel like those information can be used in explanation, but i can't figure out how you could use that to impact the $ savings
__________________
Would I rather be feared or loved? Easy. Both. I want people to be afraid of how much they love me -Michael (The Office)
Reply With Quote
  #42  
Old 06-18-2012, 11:46 AM
ebeebs ebeebs is offline
Member
SOA
 
Join Date: Jul 2008
Location: New England
Posts: 2,989
Default

I feel like the task 2B model solution was pretty bogus. It just repeated the same thing a lot, and didn't really offer anything new in question 3 when it asked for OTHER initiatives.

I think I did alright on 2A and 3 though, I hope they pass me otherwise I'll be back here in 6 weeks.
Reply With Quote
  #43  
Old 06-29-2012, 10:57 AM
dsk dsk is offline
Member
SOA
 
Join Date: Nov 2009
Posts: 67
Default

Quote:
Originally Posted by stallion78 View Post
As I was working through Task 2A, part 2, I felt like I needed to adjust for two things. (1) Assume that PPO members switching to the EPO do not change age/gender factors, therefore, I changed the EPO PEPM to reflect the age/gender characteristics of the PPO members, and will compare my adjusted PPO PEPM to this. (2) Assume that the incurred claims as reported are after cost sharing and provider discounts and reflect the network utilization as described in the data. Therefore, you can back out the impact of provider discounts by in-network utilization and adjust the PPO PEPM to reflect the fact that these members going to EPO will utilize services at 100% in-network, meaning all claims get the in-network discounts.

The problem I get, after adjusting for these two things, is that the adjusted EPO PEPM is HIGHER than the adjusted PPO PEPM in ALL locations. I really enjoyed seeing that result, in case you were wondering.

I am in agreement that area adjustments aren't needed b/c we are conducting our analysis on a per-location basis.

If there is anybody out there working on this, feel free to reply to this post or PM me. I'd be curious to get others' thoughts.
________________________________________________

Update: I now disagree with my #2 above. If we wanted to separate out savings by how much is related to the actual product shift, i.e. change in benefits, then we would want to take this approach. But BIG really doesn't care how much is due to benefit shift vs other causes. They just want to know how much they'll save. Therefore, I think we only need to adjust for #1.

My thought process exactly. I would also like to add that while there is enough info to adjust for network utilization, it is impossible to quantify the impact of cost sharing without data regarding how many people met deductible, maxed out etc.

Regarding seattle, it seems important to note the difference between the PPO contribution and EPO contribution. All other locations, the PPO is $45-$75 more expensive while in seattle it's only $5! This explains why seattle has the highest PPO %.

If there's anyone out there working on this, I'd like to hear your thoughts.
__________________
qwerty
Reply With Quote
  #44  
Old 07-01-2012, 04:35 PM
moniccazz moniccazz is offline
Member
SOA AAA
 
Join Date: Aug 2005
Location: NYC
Studying for CE credits
College: Wisconsin
Favorite beer: BEER
Posts: 501
Default

Quote:
Originally Posted by dsk View Post

My thought process exactly. I would also like to add that while there is enough info to adjust for network utilization, it is impossible to quantify the impact of cost sharing without data regarding how many people met deductible, maxed out etc.

Regarding seattle, it seems important to note the difference between the PPO contribution and EPO contribution. All other locations, the PPO is $45-$75 more expensive while in seattle it's only $5! This explains why seattle has the highest PPO %.

If there's anyone out there working on this, I'd like to hear your thoughts.
yeah agreed, i feel like because we don't have info regarding cost share, you almost can't back out the discount differential between PPO and EPO since incurred claims i believe is after discounts and plan designs.
__________________
Would I rather be feared or loved? Easy. Both. I want people to be afraid of how much they love me -Michael (The Office)
Reply With Quote
  #45  
Old 10-19-2012, 01:21 PM
gozillasnack gozillasnack is offline
Member
SOA AAA
 
Join Date: Jan 2009
Favorite beer: Vertical Epic, Stone brewing Co.
Posts: 195
Default

Quote:
Originally Posted by stallion78 View Post
(2) Assume that the incurred claims as reported are after cost sharing and provider discounts and reflect the network utilization as described in the data. Therefore, you can back out the impact of provider discounts by in-network utilization and adjust the PPO PEPM to reflect the fact that these members going to EPO will utilize services at 100% in-network, meaning all claims get the in-network discounts.
I know he no longer agrees with this point, but he didn't mention anything about this so here's my two cents.

I don't see anyone discussing why the EPO in-network utilization is 100%, and I don't think you can actually adjust for it when you start considering cross-effects of the shift. My thought is that if the members on PPO already have access to use in-network providers then they already would, I feel like there's a reason why some of them stay with the PPO rather than the lower cost-sharing EPO, and I think it's because they NEED the out-of-network coverage. So if you really want to adjust for the difference in network coverage, you would need to know the metrics for the members in PPO who CAN switch to EPO because they don't need the out-of-network coverage versus those who do.

Yeah you can make the assumption that all members are capable of going to only in-network providers, but I just think that muddies things up a bit. Just my two cents.
Reply With Quote
  #46  
Old 10-19-2012, 05:48 PM
Tireburner10's Avatar
Tireburner10 Tireburner10 is offline
Member
SOA
 
Join Date: Jul 2010
Favorite beer: Left Hand Nitro Milk Stout
Posts: 191
Default

I agree with you on this one. I don't think we have enough information to properly use the utilization figures in the analysis. At least that's what I'll mention in my write-up.

Thoughts on the two sets of age-gender factors? I've spend two years in the medical pricing department of a large health insurance company, and we don't have separate demo factors for major medical products. I can't figure out why BIG would have two sets of demo factors, nor can I reason why the age/gender factors would change for a subset of a population if they moved from one plan to another. Therefore, in order to adjust the claims for my savings estimate, I was going to only use the PPO age/gender factors.

Thoughts?
__________________
Work to live, don't live to work. Also, http://blog.jalopnik.com/

ASA FHE Mod HF Mod, PRF Mod, DP-GH GH-Advanced, DMAC, FAC
Reply With Quote
  #47  
Old 10-19-2012, 05:50 PM
Actuarialsuck Actuarialsuck is offline
Member
 
Join Date: Sep 2007
Posts: 6,117
Default

Quote:
Originally Posted by Tireburner10 View Post
I agree with you on this one. I don't think we have enough information to properly use the utilization figures in the analysis. At least that's what I'll mention in my write-up.

Thoughts on the two sets of age-gender factors? I've spend two years in the medical pricing department of a large health insurance company, and we don't have separate demo factors for major medical products. I can't figure out why BIG would have two sets of demo factors, nor can I reason why the age/gender factors would change for a subset of a population if they moved from one plan to another. Therefore, in order to adjust the claims for my savings estimate, I was going to only use the PPO age/gender factors.

Thoughts?
Do you believe there are different utilization patterns for HMO vs. PPO or do you think they should be the same?
__________________
Quote:
Originally Posted by Buru Buru View Post
i'm not. i do not troll.
Reply With Quote
  #48  
Old 10-19-2012, 07:42 PM
Tireburner10's Avatar
Tireburner10 Tireburner10 is offline
Member
SOA
 
Join Date: Jul 2010
Favorite beer: Left Hand Nitro Milk Stout
Posts: 191
Default

I would say yes, but then I've got two questions for your one question. Where does HMO come into play for the BIG health plans, and how does utilization affect age/gender factors? I believe the answer to the second question is that it doesn't, but that'd be why I'm asking you. Confused.
__________________
Work to live, don't live to work. Also, http://blog.jalopnik.com/

ASA FHE Mod HF Mod, PRF Mod, DP-GH GH-Advanced, DMAC, FAC
Reply With Quote
  #49  
Old 10-20-2012, 09:52 AM
gozillasnack gozillasnack is offline
Member
SOA AAA
 
Join Date: Jan 2009
Favorite beer: Vertical Epic, Stone brewing Co.
Posts: 195
Default

Quote:
Originally Posted by Tireburner10 View Post
I agree with you on this one. I don't think we have enough information to properly use the utilization figures in the analysis. At least that's what I'll mention in my write-up.

Thoughts on the two sets of age-gender factors? I've spend two years in the medical pricing department of a large health insurance company, and we don't have separate demo factors for major medical products. I can't figure out why BIG would have two sets of demo factors, nor can I reason why the age/gender factors would change for a subset of a population if they moved from one plan to another. Therefore, in order to adjust the claims for my savings estimate, I was going to only use the PPO age/gender factors.

Thoughts?
The age/gender factors are probably the averages of the individual members in PPO/EPO. So if an individual member switches over, no, their factors won't change. But you have to adjust the PPO claims with the PPO factors and the EPO claims with the EPO factors.
Reply With Quote
  #50  
Old 10-20-2012, 10:36 AM
Actuarialsuck Actuarialsuck is offline
Member
 
Join Date: Sep 2007
Posts: 6,117
Default

Quote:
Originally Posted by Tireburner10 View Post
I would say yes, but then I've got two questions for your one question. Where does HMO come into play for the BIG health plans, and how does utilization affect age/gender factors? I believe the answer to the second question is that it doesn't, but that'd be why I'm asking you. Confused.
The HMO vs. PPO was just an example. And utilization does not impact a/s factors, that's not what I was trying to say. My point was that different cohorts would select an HMO vs. PPO and therefore each one would have different average a/s factor.

Quote:
Originally Posted by gozillasnack View Post
The age/gender factors are probably the averages of the individual members in PPO/EPO. So if an individual member switches over, no, their factors won't change. But you have to adjust the PPO claims with the PPO factors and the EPO claims with the EPO factors.
Yes. I'd agree with that.
__________________
Quote:
Originally Posted by Buru Buru View Post
i'm not. i do not troll.
Reply With Quote
Reply

Thread Tools Search this Thread
Search this Thread:

Advanced Search
Display Modes

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is On
HTML code is Off


All times are GMT -4. The time now is 07:42 AM.


Powered by vBulletin®
Copyright ©2000 - 2018, Jelsoft Enterprises Ltd.
*PLEASE NOTE: Posts are not checked for accuracy, and do not
represent the views of the Actuarial Outpost or its sponsors.
Page generated in 0.24434 seconds with 9 queries