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  #101  
Old 04-14-2019, 04:21 PM
nguye569 nguye569 is offline
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Thanks for the thorough response. I read this and went back through some of the source material and this is making sense to me.

Quote:
Originally Posted by MATEseminars.dc View Post
First off for others that would like to follow along if you do not have the MATE practice problem set this question is based on the Fall 2014 exam # 7f

Your math is correct but I want to make two clarifying points:

The first is that PDR's need to be determined by looking at your net gains each year and not in total for the life time of the policy. I think this can be confusing because a GPV is basically looking at the PV of all yearly cash flow. But there is guidance from the HRGM that tells actuaries to look at this on a period by period basis, for important reasons but I will digress on that point. In this particular example, the take away is that the amount of the PDR is saying "hey everyone we expect losses in the short term, they are going to be $35 over the next two years". After that two year period we expect to have gains. So you set up the PDR at the beginning of the year to be 35.

The second point is that if you just do a regular GPV you get the answer you got of negative 25 ... the interpretation of that would be saying "hey everyone nothing to see here we are going to be $25 to the good over the life time of the policy so there is no need to be concerned." But in reality you are masking losses in some years with gains in future years.

Please note that all of my comments are in regards to this particular question and that determining whether to set up a PDR in reality can be part of the "art" as much as the "science".

I hope that helps.
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  #102  
Old 04-16-2019, 06:50 PM
ShouldHaveDoneCompSci ShouldHaveDoneCompSci is offline
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Regarding MACRA stuff - what is meant by "Attribution-eligible" beneficiaries? Does that mean you have to have a certain % market share to be a Qualifying APM Entity?

I'm thinking in terms of MSSP - an ACO could have 5000 members assigned to them, in an area where there are 50,000 FFS enrollees who could have been attributed to them. So their "Patient Count" threshold score is 10%? That doesn't seem reasonable at all. The requirement is going up to 50% in 2021.
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  #103  
Old 04-18-2019, 07:58 PM
scott.ac scott.ac is offline
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Quote:
Originally Posted by ShouldHaveDoneCompSci View Post
Regarding MACRA stuff - what is meant by "Attribution-eligible" beneficiaries? Does that mean you have to have a certain % market share to be a Qualifying APM Entity?

I'm thinking in terms of MSSP - an ACO could have 5000 members assigned to them, in an area where there are 50,000 FFS enrollees who could have been attributed to them. So their "Patient Count" threshold score is 10%? That doesn't seem reasonable at all. The requirement is going up to 50% in 2021.
Good question, wonder if it is ( attributed to ACO ) / ( seen by the ACO that were attributable)?
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  #104  
Old 04-22-2019, 02:37 PM
MSPActuary MSPActuary is offline
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I'm working on past exams as practice exams. Fall 2016 Question #7 has 3 sub-questions on Plausibility Factors. Anyone know for sure if this is still on the syllabus? I'm thinking it was removed? TIA's list of exams / questions removed has ID'd these questions as still being on the syllabus, so just want to get some other thoughts...
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  #105  
Old 04-22-2019, 03:17 PM
Latitude30 Latitude30 is offline
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Very important question.

For a Long Duration contract with a Year 1 claim of $5,000
5% interest rate
Lapses are 20% each year
Premiums paid beginning of the year
Losses occur mid-year

How would you discount the year 1 cash flow ?
Would it be $5,000 times (1+.8)/2 times (1.05)^-0.5?

Or would it be $5,000*(1)*(1.05^-0.5)?

I notice for a disability question ignoring an elimination period, the former is correct?

But long duration annuity questions the premium lapse is set equal to the claim’s regardless of when during the year the loss comes in. Why?
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  #106  
Old 04-22-2019, 05:53 PM
Mathdube2 Mathdube2 is offline
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Quote:
Originally Posted by Latitude30 View Post
Very important question.

For a Long Duration contract with a Year 1 claim of $5,000
5% interest rate
Lapses are 20% each year
Premiums paid beginning of the year
Losses occur mid-year

How would you discount the year 1 cash flow ?
Would it be $5,000 times (1+.8)/2 times (1.05)^-0.5?

Or would it be $5,000*(1)*(1.05^-0.5)?

I notice for a disability question ignoring an elimination period, the former is correct?

But long duration annuity questions the premium lapse is set equal to the claim’s regardless of when during the year the loss comes in. Why?
Would you lapse in the middle of the year if you paid for the whole year?
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  #107  
Old 04-22-2019, 06:17 PM
ncrifa1 ncrifa1 is offline
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Quote:
Originally Posted by MSPActuary View Post
I'm working on past exams as practice exams. Fall 2016 Question #7 has 3 sub-questions on Plausibility Factors. Anyone know for sure if this is still on the syllabus? I'm thinking it was removed? TIA's list of exams / questions removed has ID'd these questions as still being on the syllabus, so just want to get some other thoughts...
I can't say for sure, but I did go through the sources thoroughly. The only mention of plausibility measures is the inclusion of "plausibility metrics" in the EHM value chain. I haven't seen material on the solutions for #7b-d.
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  #108  
Old 04-22-2019, 11:05 PM
PoisedGiraffe PoisedGiraffe is offline
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Quote:
Originally Posted by MSPActuary View Post
I'm working on past exams as practice exams. Fall 2016 Question #7 has 3 sub-questions on Plausibility Factors. Anyone know for sure if this is still on the syllabus? I'm thinking it was removed? TIA's list of exams / questions removed has ID'd these questions as still being on the syllabus, so just want to get some other thoughts...
I think TIA kept in questions that refer to "background only" chapters on the syllabus. I took this to be one of those (I want to say Duncan Chapter 4 or 10, though I can't recall off the top of my head).

The background is technically on the syllabus but I'd be shocked if they asked any questions on it
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  #109  
Old 04-22-2019, 11:05 PM
MSPActuary MSPActuary is offline
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Quote:
Originally Posted by ncrifa1 View Post
I can't say for sure, but I did go through the sources thoroughly. The only mention of plausibility measures is the inclusion of "plausibility metrics" in the EHM value chain. I haven't seen material on the solutions for #7b-d.
Helpful, thanks!
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  #110  
Old 04-22-2019, 11:13 PM
PoisedGiraffe PoisedGiraffe is offline
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Question on the ACO shared savings-specifically regarding adjusting the benchmarks for performance years. Did a problem earlier today with separate risk and age/gender factors for the performance years. The solution said to always apply age/gender, but only apply risk score if it decreased.

I was re-reading Duncan 22.7 (in the predictive modeling book) and they show an example in table 22.4 that shows risk adjustment for each category. Half have risk score decrease and half have risk score increase, but they apply the factor to each category's spending benchmark anyways. The key states these are based on HCC factors (so presumably risk, not demographic).

Can someone help me reconcile why this example adjusts for the risk score, even when it went up?
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