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2002年度11月份北美精算师考试真题November2002Course8M（四）

来源：高顿网校 2014-08-27

　　以下是高顿网校小编花了45分钟为您整理的考前珍贵资料：2002年度11月份北美精算师考试真题November2002Course8M（四）。
　　13. (5 points) You are a product development actuary working for a multi- line insurance

　　company. The company is developing an individual medical insurance product.

　　(a) Outline the types of premium rate and renewal guarantees that may be used and

　　characteristics of each.

　　(b) Describe factors that influence the level of lapsation rates for these types of

　　policies.

　　major medical insurance.

　　(d) Describe sources of information the underwriter might utilize.

　　14. (3 points) You are an actuary for JKL Life which has recently decided to enter the group

　　medical line of business. You have been asked to lead a project to design the needed

　　management information system.

　　(a) Review the challenges of producing management information reports.

　　(b) Describe information/reports that would be useful to analyze claims and expenses.

　　COURSE 8: Fall 2002 -12- GO ON TO NEXT PAGE

　　Managed Care Segment

　　Afternoon Session

　　Questions 15 – 17 pertain to the Case Study

　　15. (6 points) You are an actuary for the Bedford Group. In a meeting with the VP of

　　Provider Contracts, you are told that IPA1 and IPA3 are considering consolidating

　　operations and would like to meet next week to formulate a new contract.

　　Your CEO is concerned that this consolidation would impact physician contracts. She

　　wants to hold physician costs for all IPA’s prior to any risk-share arrangements to 125%

　　of 2000 Medicare RBRVS.

　　Using Tables MC-5 and MC-7:

　　(a) Review the advantages and disadvantages of different contracting arrangements

　　between physician entities and managed care companies.

　　(b) Describe the legal structure of an IPA and explain why IPA1 and IPA3 may or

　　may not want to consolidate.

　　Show your work.

　　(d) Calculate the percentage of 2000 Medicare RBRVS that must be negotiated with

　　the consolidated IPA in order to meet the CEO’s requirements. Show your work.

　　COURSE 8: Fall 2002 -13- GO ON TO NEXT PAGE

　　Managed Care Segment

　　Afternoon Session

　　Questions 15 – 17 pertain to the Case Study

　　16. (4 points) You are an actuary for the Bedford Group. Hospital ID 1 has been

　　successful with its Maternity case rate and would like to consider moving to a

　　case rate or capitation reimbursement for its Medical and Surgical services.

　　Using Tables MC-2 and MC-7:

　　(a) Explain differences between case rate, capitation and per diem reimbursement

　　arrangements and provide reasons why Hospital ID 1 may want to consider

　　changing.

　　(b) Calculate a combined case rate for all Medical and Surgical inpatient services for

　　Hospital ID 1 using 2001 experience. Show your work.

　　its current contract.

　　COURSE 8: Fall 2002 -14- GO ON TO NEXT PAGE

　　Managed Care Segment

　　Afternoon Session

　　Questions 15 – 17 pertain to the Case Study

　　17. (12 points) You are the Chief Actuary for the Bedford Group and have been approached

　　by a vendor offering demand management programs. You have determined that these

　　programs can save 5% per year on Hospital ID 1 inpatient medical and surgical claims at

　　a cost of $150,000 per year in administrative expenses.

　　In recent years Hospital ID 1 has been approaching full capacity of its inpatient

　　beds. They are considering implementing a clinical pathways program. The

　　hospital estimates that by implementing the program, it can reduce its medical and

　　surgical inpatient days by 10%. Implementation cost for the program is estimated

　　to be $250,000. Hospital ID 1 has approached you to share in half the

　　implementation cost and to increase their reimbursement by 5% to recognize the

　　improvement in care.

　　In addition to inpatient claims, the Bedford Group paid $57,960,000 in outpatient

　　claims to Hospital ID 1 in 2001. Assume no other contract provisions change and

　　membership and utilization remain at 2001 levels.

　　Using Tables MC-2, MC-3, MC-7, and MC-8:

　　(a) (2 points) Compare and contrast disease management and demand manageme nt.

　　(b) (2 points) Describe clinical pathways and their possible uses.

　　the Bedford Group for the following programs:

　　(i) clinical pathways

　　(ii) demand management

　　(d) (2 points) Due to limited resources, only one of the two programs may be

　　implemented. Recommend which program you would choose. Support your

　　recommendation and show any related work.

　　COURSE 8: Fall 2002 -15- GO ON TO NEXT PAGE

　　Managed Care Segment

　　Afternoon Session
　　人生的奋斗可以分五个阶段：为了生存下来，立足社会。改善生活，提高品质。有点成就，需要炫耀，让更多人知道自己的成功。阅历多了，开始追求感觉的东西。归朴还真，上升到精神的境界。——高顿网校名人心语

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