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  #61  
Old 07-25-2014, 07:55 PM
Actuary1129 Actuary1129 is offline
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Quote:
mathmajor, where are you getting 256.96? The HMO high P0002 net claim PMPM I see given is $177.33. Consequently I'm getting a much lower manual claim PMPM.
$256.96 is the expected claim cost PMPM for 2011 taken from the earlier case study work, divided by the target loss ratio.
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  #62  
Old 10-07-2014, 06:35 PM
UFActuary UFActuary is offline
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I think you might want to calculate Ben factor for adjusted Plan0001 starting from the original Plan0001

That would mean find factor relative to old plan 0001 and then multiply this by the .85 benefit factor to get the change from high cost plan....instead of take direct relativity from new plan to high plan

Reason I might do this...as opposed to ignoring the original plan 0001 completely
is to account for plan design dollar amounts like Rehab that we didn't use in cost model and that we can assume is imbedded in the plan0001 Ben factor and not that high plan
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  #63  
Old 01-14-2015, 04:04 PM
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Originally Posted by Sir Deicide View Post
We don't know what the experience period is, we don't know if provider discounts have changed, and the copay assumptions are variable.
Yeah, I don't see how I can glean the information I need to set a reliable experience rate from the $186.23 PMPM figure, when we have no idea what discounts the incumbent carrier was getting.

Maybe the prospect is a high-morbidity group, but the carrier got deep discounts.

Maybe they are young, healthy people, but the carrier is a little TPA with a rental network that has to pay at or near the chargemaster price.

CRIC needs to charge a higher premium in the first case than in the second.
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  #64  
Old 01-14-2015, 05:38 PM
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Where are Meanie506 and mathmajor getting the 0.95 size factor applicable to the manual rate for a 2000-member group? I can't find it in the course materials.
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  #65  
Old 01-14-2015, 06:41 PM
Actuarialsuck Actuarialsuck is online now
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Originally Posted by Atropellador View Post
Where are Meanie506 and mathmajor getting the 0.95 size factor applicable to the manual rate for a 2000-member group? I can't find it in the course materials.
On the "Data2-BenefitIndex" tab, doesn't it have a table that says:

Size Factor Scale
Size Factor
>1,000 0.95
300-1,000 0.98
100-300 1
51-100 1.02
<50 1.1
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  #66  
Old 01-14-2015, 10:18 PM
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Ah, yes, thanks. I was thinking it was off with the starting manual rate, and read right past that.
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  #67  
Old 02-09-2015, 04:57 PM
actuary2015 actuary2015 is offline
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I got the following numbers:

manual premium: $159
experience premium: $211
final premium: $205

My manual premium seems to be much lower than what most people have posted above...
1. started off with the $177.33 given for P0002
2. adjusted for benefit design - first by 0.85 to P0001, then by a factor to reflect the difference in claims cost in the cost model for P0001 and the new plan => overall factor of 0.80
3. multiplied by size factor of 0.95
4. divided by 85% target loss ratio
(assumed the cost model provided was for 2011 and therefore no trend adj required)

My experience premium seems to be consistent with what others have got.

Anyone else getting similar numbers to mine?
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Last edited by actuary2015; 02-09-2015 at 05:45 PM..
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  #68  
Old 03-27-2015, 12:15 PM
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doublebourbon doublebourbon is offline
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I'm struggling with the experience PMPM, particularly in getting the benefit factor for the new plan.

1) Copy P0002 model and adjust copay/utl for old plan
-Hospital Inpatient to $350 (no utl impact)
- Hospital Outpatient to $150 (no utl impact)
- ER remains at $100 (no utl impact)
- Physician goes to $15/$25 at 70%/30% to come out to $18 (reducing Office Visits and Other by 80 visits)
- Rx to $10/$40 at 70%/30% to come out to $19 (reducing Scripts/1000 by 625)
- Gross PMPM Cost = 201.79
2) Copy P0002 model and adjust copay/utl for new plan
-Hospital Inpatient to $500 (no utl impact)
- Hospital Outpatient to $250 (no utl impact)
- ER to 250 (reduce cases/1000 by 20)
- Physician goes to $20/$40 at 70%/30% to come out to $26 (reducing Office Visits and Other by 208 visits)
- Rx to $15/$50 at 70%/30% to come out to $25.50 (reducing Scripts/1000 by 1437.50)
- Gross PMPM Cost = 194.81
3) Benefit Factor = 194.81 / 201.79 = 0.9654

What am I missing? Why is my factor higher than everyone elses?
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  #69  
Old 03-27-2015, 12:43 PM
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Quote:
Originally Posted by doublebourbon View Post
3) Benefit Factor = 194.81 / 201.79 = 0.9654

What am I missing? Why is my factor higher than everyone elses?
By ratio'ing gross PMPM cost rather than net PMPM cost, you are capturing only the effects of the induced utilization, not the direct effects of the changes in cost sharing.
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  #70  
Old 03-27-2015, 01:02 PM
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Quote:
Originally Posted by Atropellador View Post
By ratio'ing gross PMPM cost rather than net PMPM cost, you are capturing only the effects of the induced utilization, not the direct effects of the changes in cost sharing.
The benefit factor I get from net costs is 0.8599. Which after 11% trend and 85% MER, results in $209 PMPM for 2011. Still less than what others have recently posted but I guess that's what I'll go with.

Thank you.
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