精算师历年北美考场SOA真题2001NovemberCourse8M（第四课）的内容很多，可采用滚雪球的方法记忆。
　　15. Continued
　　(c) (2 points) Outline issues you would consider in determining whether carve-out is
　　preferable to carve-in strategies for both BH/CD and for radiology services.
　　(d) (1 point) Calculate the capitation rate for physician radiology services for the year
　　2001 using the case study data and assuming the VP of Provider Contracts’
　　prediction is correct. Show your work.
　　(e) (7 points) Calculate the capitation LBS would have charged in 2000 based on
　　The Bedford Group’s actual utilization experience. Determine the financial
　　impact to The Bedford Group in 2000 if LBS’ assumptions had been true. Show
　　your work.
　　COURSE 8: November 2001 -14- GO ON TO NEXT PAGE
　　Managed Care
　　Afternoon Session
　　Questions 14 through 16 pertain to the Case Study
 
　　16. (4 points) As the Actuary for The Bedford Group, you have been discussing the hospital
　　inpatient utilization with the Medical Director. The table below shows the unmanaged
　　and optimal utilization levels reflecting The Bedford Group’s demographic mix and
　　geographic location.
　　Assume the table below applies for both 2000 and 2001.
　　Admits /1,000 Days /1,000
　　Unmanaged 75 345
　　Optimally Managed 55 180
　　(a) Calculate the actual 2000 and budgeted 2001 degree of healthcare management
　　for The Bedford Group using data from Table MC-4. Outline factors to consider
　　when *uating the hospital utilization and cost data. Show your work.
　　(b) Outline a report to the Medical Director that describes medical management
　　approaches that may be used to meet budgeted utilization for 2001.
　　COURSE 8: November 2001 -15- GO ON TO NEXT PAGE
　　Managed Care
　　Afternoon Session
 
　　17. (4 points) You are a consulting actuary for an HMO *uating a prescription drug
　　benefit program for its health plans. You will be making a presentation to the Board and
　　will need to include the following:
　　(a) Describe the three general categories of prescription drugs as distinguished by
　　manufacturers’ patents.
　　(b) Outline plan features used to control prescription drug average charges and utilization.
　　(c) Describe functions performed by a Pharmacy Benefit Manager (PBM) and how a PBM can
　　manage drug costs.
　　COURSE 8: November 2001 -16- STOP
　　Managed Care Segment
　　Afternoon Session
 
　　18. (7 points) You are the financial actuary for PDQ HMO and have been asked by your
　　CFO to develop an operating statement forecast for 2002. PDQ sells exclusively
　　commercial group business. PDQ is considering the financial impact of several changes
　　which are targeted to occur on July 1, 2002.
　　(a) Describe the components of an operating statement. Discuss assumptions needed
　　for forecasting an operating statement for PDQ.
　　(b) The claim administration system will become more automated to increase
　　efficiency. Describe the impact of this change on your forecast assumptions.
　　(c) PDQ has a staff model HMO subsidiary, DOX. Market pressures may force DOX
　　to move to an IPA model. Describe how this change might impact your forecast
　　assumptions for DOX.
　　(d) Your Medical Director will implement stricter utilization management controls
　　and initiate a Disease Management (DM) program. To accomplish this, she will
　　be contracting with an outside vendor for disease management services. Describe
　　the impact of these initiatives on your forecast assumptions. Discuss how your
　　assumptions would differ if the DM program were developed in-house.
　　(e) The jurisdiction in which PDQ is domiciled is implementing a premium tax, a
　　high risk pool charge, and mandated benefits covering services previously
　　excluded from your policies. Describe how these reforms will impact your
　　forecast assumptions.
　　你们之间存在着这种问题，那你要先问问自己，是否真正在爱才好。——高顿网校为人处世

 

 
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