Apothegm Perspective Rating System
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description
Apothegm’s Perspective Rating System™ is our flagship health plan pricing suite. Use our Retrospective Renewal Management Tool™ experience pricing model to develop multiple strategies by health plan or business line. Drive new business with the Prospective New Sales Pricing Tool™. Measure, analyze and manage the entire process with our Introspective Reporting and Analysis Tool™. Learn more about all the applications in Perspective below…
Transcript of Apothegm Perspective Rating System
Model Rating Strategies
•Experience Rating
•Manual Rating
Compare Enterprise Level Results
•Actual vs. Expected
Primary Deliverables…
Monitor Rating Strategy and impacts to the
distribution of Rate Increases and Loss Ratio by:
Features
•Health Plan
•Business Segment
•Group
•Plan
Test the implications of rating variables across
multiple years and apply different methodologies
by user defined Group Size…
Features
Manage variations in plans from group to group
with Claims Normalization and Adjustment
process…
Features
Experience Period Claims
Remove Experience Period Plan
Factor(s)
NormalizedClaims
Adjust Claims to Current Plan
Factor(s)
AdjustedClaims
Adjust Claims to Current
Enrollment Distribution
Examine and balance Pooling Charges and
Pooling Credits…
ExcessClaims
Total Claims
TrendIndexing
DollarTo
Dollar
Features
Large Claims
Pooling Credit and Charges
Apply Trends by:
•Year
•Plan
•Medical and Rx
Features
Rating Process
10 Stage Actuarial Rating Engine
• Rating data is processed modularly in 10 steps. This provides for:
• Simplification of rating method; greatly reducing the time and effort needed
to update or change components within the rating process.
• Greater flexibility in adapting to new business needs.
• Easy auditing of rating data.
• Rapid recalculation of rates after manipulation of rating variables.
Paid Claims
Large Claims
Claims Normalization
and Adjustment
Pooling Experience Rate
Summary Data and Extracts
Credibility Blended
Rate
Presentation Rate
Rating ProcessRatingProcessStages
Manual Rate
Enrollment(Current and Experience
Period)
Rating processData extraction flow
Experience Rate
Credibility Blended
Rate
Rating ProcessControls
Set ranges for group Pooling Class…
Set Pooling Point by Class…
Set Pooling Method by Class…
Balance Pooling and Large Claims
Rating ProcessControls
Manage size classification, Plans, and Trend…
Rating ProcessControls
Set the experience period and contract duration…
Adjust credibility…
Experience Rate
Credibility Blended
Rate
Rating ProcessControls
Create customizable Large Claim Reports…
