北美精算师的考生们，你们7月21号上午好，欢迎前来阅读SOA北美精算师历年真题November2004Course8M（最后一部分）。
　　18.(7points)TheBedfordGroupisrenegotiating2004providercontracts.Thecontracting
　　unitisproposingreimbursementincreasestoHospitalID2of15%forMedicaland
　　Surgicaland10%forallotherservices.Inaddition,theMedicalDirectorhasreviewed
　　HospitalID2MedicalandSurgicalchartsanddeterminedthefollowing:
　　ChartReviewResults
　　?  5%ofadmitsareunnecessary
　　?  15%ofdaysareunnecessary
　　?  ExcessadmitsanddaysareevenlydistributedbetweenMedicalandSurgical
　　services
　　UsingTablesMC-2,MC-3,MC-4,andMC-7
　　(a)(3points)CalculatethereimbursementforunnecessarycareprovidedatHospital
　　ID2for2003.Showyourwork.
　　(b)(3points)Forecast2004paymentstoHospitalID2formedicalandpsychiatric
　　servicesthatreflect:
　　?  proposedhospitalreimbursementincreases,
　　?  allpotentialutilizationsavingsfromthechartreview,
　　?  budgetedutilizati*sforpsychiatricservices
　　Showyourwork.
　　(c)(1point)DescribeissuesregardinghospitalclaimsubmissionsfacedbyMCOs
　　andclaimreviewmethodsusedtoidentifyandaddresstheseissues.
 
　　COURSE8:Fall2004-14-GOTONEXTPAGE
　　ManagedCareSegment
　　AfternoonSession
　　Questions17–19pertaintotheCaseStudy
　　19.(7points)AstheCFOoftheBedfordgroupyouareconcernedaboutthevolatilityof
　　EarningsBeforeTaxesasshowninTableMC-1.InadditiontotheinformationTable
　　MC-1,youareprovidedthefollowing:
　　MembershipChangeNonefor2004or2005
　　Expected2004PremiumIncrease6%
　　PaidClaimsTrend10%peryearfor2004and2005
　　IBNREstimate2.0monthsofprior12monthspaidclaims
　　AdminTrend3%peryearfor2004and2005
　　AveragePremiumTax1%ofpremiumfor2004and2005
　　InvestmentIncomeRate3%peryearfor2004,4%for2005
　　Corporatetaxrate0%for2004and2005
　　Surplusatendof2003$350,000,000
　　Assumenochangestothe2003IncomeStatementandBalanceSheetotherthanthose
　　listedabove.
　　(a)(6points)TheBoardisexpecting2005OperatingEarningstobe5%ofpremium.
　　Developtheoverall2005premiumincreaseneededtomeetthisgoal.
　　Showyourwork.
　　(b)(1point)Describesourcesotherthanpremiumthatcanbeusedtoincrease
　　OperatingEarnings.
 
　　COURSE8:Fall2004-15-GOTONEXTPAGE
　　ManagedCareSegment
　　AfternoonSession
　　20.(3points)YouarethechiefactuaryforXYZmanagedcarecompany.Youhave
　　observedaveryhightrendinambulatorycareservicesandwanttoimplementaseries
　　reportstoanalyzeandaddressthisissue.YourChiefMedicalOfficerisconcernedabout
　　thereactionofproviderstobeingprofiled.
　　(a)Liststatisticalconsiderationswhenchoosinganambulatorycasemixsystem.
　　(b)Describegeneraltypesofreportsyouwoulddevelopforplanmanagementof
　　providercosts.
　　(c)Defineproviderprofiling,identifyitsuses,andlisttheprinciplesyourprovider
　　profilingsystemwillfollowtoensurethatthereportsarefairanduseful.
　　21.(4points)Youareanactuaryforahealthcarrierthatwantstoaddadiseasemanagement
　　programtohelpcontrolcostsandattractmoreself-fundedemployerbusiness.
　　(a)Describecharacteristicsthatcontributetoasuccessfuldiseasemanagement
　　program.
　　(b)Describebarriersanddriversforimplementationofadiseasemanagement
　　program.
　　(c)Listthefeaturesthatdistinguishdiseasemanagementfromconventionalmedical
　　management.
　　(d)ExplainpotentialrisksinvolvedwithusingtheInternetasadiseasemanagement
　　tool.
 
　　COURSE8:Fall2004-16-STOP
　　ManagedCareSegment
　　AfternoonSession
　　22.(3points)Youareaconsultingactuaryassistingagroupofphysicianstodetermine
　　whetherthegroupshouldformafeeforserviceorprepaidpractice.
　　(a)Comparemajorrisksforaprepaidpracticerelativetoafeeforservicepractice.
　　(b)Outlinealternativesthegroupcouldusetomanageprepaidfinancialrisk.
　　**ENDOFEXAMINATION**
　　AFTERNOONSESSION
　　高顿网校之淳淳教诲：真理诚然是一个崇高的字眼，然而更是一桩崇高的业绩。如果人的心灵与情感依然健康，则其心潮必将为之激荡不已。 —— 黑格尔