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  #81  
Old 06-30-2016, 03:16 PM
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Salmon Hatchery Salmon Hatchery is offline
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anyone working on this now?
Yeah I'm working on this
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  #82  
Old 06-30-2016, 04:29 PM
Msandler Msandler is offline
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I'm having some trouble with Task 2B.

In #1, for outlining key reasons that Seattle's historical costs are higher than other markets, it specifically states "based on the data made available," so all we really have to go on is the average in-network provider discount(which is lower than average, but not the lowest and "Other" has a lower average in-network provider discount and ~40% lower cost, so that can't fully explain it) and the demographic/chronic condition info by region. Seattle is squarely within the range for all measures except for average annual salary in which they are the lowest. But I can't really draw any direct link between low salary and high healthcare expenditures geographically.

Then in #2 it asks to explain how a high-deductible plan would address each of the key cost drivers from #1. I can write generally how a high deductible plan might alter behavior, shift incentives and help save money overall, but not specifically how it would work for this population. I guess if I get a better understanding/better answer for #1 this could easily follow but not seeing how it comes together yet.

Any insight?
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  #83  
Old 06-30-2016, 06:40 PM
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I'm looking at a couple things. First thing is because Seattle has a much larger portion of enrolled in the PPO plan as compared to the other locations. Having such a large portion in the PPO plan exposes that group to more inefficiencies in regional network discounts and higher claims costs. Also Seattle has the lowest average salaries, and as one of the module readings mentioned, low income can imply high claims and utilization (although probably not actually true for Seattle)

Also i don't think you can compare the "Other" group of employees since they don't have a defined geographic location and a much different network and EPO for them is almost non-existent. I see "Other" as kind of an ill defined and unquantifiable group, members of that group probably don't share a lot of the same qualities.
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  #84  
Old 10-21-2016, 07:23 PM
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Is anyone currently working on this? If so, please PM.
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  #85  
Old 11-29-2016, 11:12 PM
Dug the Dog Dug the Dog is offline
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Anybody working on this right now?
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  #86  
Old 01-12-2017, 05:09 PM
vanl0953 vanl0953 is offline
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There is a difference. If you read the introduction:
*Both PPO and EPO use same provider network, the EPO provides additional cost controls through enhanced care management via a medical home concept
*Care for the typical EPO enrollee is managed by a primary care physician practice


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Originally Posted by jhn31 View Post
I think we should assume that there are more benefits than just those listed, right? For example, the PPO probably has a much more favorable set of Inpatient Hospital benefits than the EPO, which is why some (probably higher-risk) people choose it.

The EPO doesn't have the $1,000 OOP Maximum, but it's not like an EPO member is going to get anywhere close to that on $10 office copays anyway. Therefore, there must be some kind of unmentioned Inpatient benefit that could cause EPO members to rack up more than $1,000 OOP if they are hospitalized.
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  #87  
Old 01-12-2017, 05:11 PM
vanl0953 vanl0953 is offline
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I would not include this difference in premium, as we are not given the amount paid by the company to the insurance company, just the employer contribution. There isn't enough information to back out the actual payment to the insurance company, so ignore this.

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I'm wondering the same thing.
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  #88  
Old 01-25-2017, 01:44 AM
RanaEgypt RanaEgypt is offline
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Does anyone have additional thoughts on including the change in employee contributions when developing the "savings" for task 2a?

It makes sense to me to include this because for any analysis for a self-insured customer, this would have to included. But it seems to me that the SOA was not intending us to do this otherwise they would have given employee contribution rates that made more sense.

Like earlier posts, I calculated that the 1% migration would result in claims cost savings of about $98K. If I take the associated drop in employee contributions from encouraging PPO members to switch to EPO plans, I get a loss of $312K, which more than obliterates the claims savings.

Any thoughts on this? I'm leaning towards including the claims cost savings so that it's clear that I calculated it correctly and then noting that Big would also see a major loss in employee contributions by pursuing this route.

Any advice or thoughts would be appreciated!
I was wondering about the same thing and had an additional thought. Yes, the company would lose on employee contributions, but wouldn't it save on company contributions. I do not live in the US so I'm not familiar with the system. BIG also pays contributions on behalf of its employees (we were just not given the information in the exercise), correct?
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  #89  
Old 02-23-2017, 10:35 AM
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I'm working on this right now. This thread is super helpful!
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  #90  
Old 07-12-2017, 04:06 PM
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trondogss trondogss is offline
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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.
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