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精算师历年北美考场SOA真题2001NovemberCourse8M（第四课）

来源：高顿网校 2014-08-22

　　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 evaluating 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 evaluating 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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