GBA 3: Assignment 3 Exam Questions
and Answers (Solved Papers) What 3 factors are typically used to predict the individual use of health services? - Correct Answers ✅1. individual's demographics (performs poorly)
- Individual's health status
- Prior utilization (best predictor)
- some sets of measures are better predictors than others
- statistical modeling has its limits. other approaches may
- legislation prescribed that the capitated rate should be 95%
- basically a simple manual rating system
- this gave HMOs incentive to enroll people with lower-than-
Discuss 3 key points that emerge from the process of risk adjustment for the purpose of setting premiums. - Correct Answers ✅1. even the most complete set of measures explains only a small proportion of variance in an individual's use of health services.
contain more or better information than statistical models Describe the development of the Medicare payment methodology known as the Adjusted Per Capita Cost (AAPCC) to reimburse Medicare Advantage (MA) plans. - Correct Answers ✅- Medicare started by paying participating HMOs a fixed dollar amount for each beneficiary who joined the plan
of the avg Medicare Part A plus B expenditures per beneficiary, adjusted by age, gender, Medicaid status, etc.
average claims and avoiding those with high claims1 1 / 2
GBA 3: Assignment 3 Exam Questions
and Answers (Solved Papers) What was the objective of the influential RAND Health Insurance Experiment study? - Correct Answers ✅- to examine the effects of insurance copayment arrangements on expenditures with the hope of improving the AAPCC model for Medicare
- study randomly assigned people from 6 sites in different
- most of the knowledge of the measurement of health status
- Subjective Health Status Measures (pysical health, mental
- Physiological Health Status Measures (dichotomous
- Prior Utilization (outpatient and inpatient expense in prior
- / 2
health plans and monitored usage for 4-5 years in the 1970s
has its genesis with this study What are the 4 measures of used for setting premiums according to the RAND study and which is the best? - Correct Answers ✅1. Demographic Measures (Age, gender, location, eligible for welfare)
health, general health & disease count)
measure, continuous measure - cholesterol, diabetes, etc)
year) **prior utilization is the best How did the Balanced Budget Act of 1997 (BBA) change the risk adjustment methodology on which the AAPCC payment was based? - Correct Answers ✅- it required Medicare to