experience and migration predictive user manual...5) finalize experience: function button to...

Experience and Migration Predictive © Claros Analytics. All Rights Reserved.

Health Benefits Consulting Suite

Experience and Migration Predictive

User Manual

Experience and Migration Predictive Version 5.0.0

September 2017


Table of Contents CLAROS ANALYTICS Health Benefits Consulting Suite ............................................................................................................ 3

Experience and Migration Predictive Solution – Overview .................................................................................................... 3

The Interface ........................................................................................................................................................................... 4

Setting Up the Solution ........................................................................................................................................................... 6

Experience Setup ................................................................................................................................................................ 6

Plan Setup ........................................................................................................................................................................... 8

Design Plan ...................................................................................................................................................................... 8

Enrollment Details ......................................................................................................................................................... 10

Current Year Setup ............................................................................................................................................................ 11

Experience Exhibit ............................................................................................................................................................. 12

Enrollment Migration Prediction .......................................................................................................................................... 13

Projection Year + Migration .............................................................................................................................................. 13

Projection Year Budget Rates ........................................................................................................................................... 16

Budget Rate Margin Setup ................................................................................................................................................ 18

Load a Scenario Plan from the Archive ............................................................................................................................. 20

Archive: Saving Scenarios.................................................................................................................................................. 21

Saving Scenarios to the Archive ........................................................................................................................................ 21

Print & Export Outputs.......................................................................................................................................................... 22


CLAROS ANALYTICS Health Benefits Consulting Suite The Health Benefits Consulting Suite is built on the foundation of our Actuarial Advisor rating manual; Actuarial Advisor

is used by health plans, stop-loss insurers, reinsurance carriers, and consulting actuaries.

Solutions in the Health Benefits Consulting Suite help decision makers and advisors to better understand the dynamics

and risks of plans design options in order to craft more refined and efficient health benefit plans.

These solutions are used by underwriters, TPAs, benefits consultants, plan advisors, insurance brokers and plan

sponsors.

In version 5.1, the model’s detailed claim distributions are based on a claims data set that has more than 10 million lives

and more than $100 billion in billed charges. The data set is updated annually in order to capture and utilize the most

recent healthcare trends. The size and richness of the database allows for the development of claim distributions that

reflect 34 medical service categories, 8 pharmaceutical categories and over 200 claim size ranges.

Experience and Migration Predictive Solution – Overview Experience and Migration Predictive (EM) is a component of the Health Benefits Consulting Suite.

Experience/Migration Predictive provides a consistent and actuarially robust methodology for the calculation of experience analysis and budget rate development, and then offers a predictive twist. Utilizing up to three years of a group’s claims data, the predictive solution normalizes data for large claims, and adjusts yearly for changes in demographics, plan design and other factors. The plan’s migration algorithm can then forecast where plan participants are expected enroll given past benefit decisions and simulated future requirements. The solution can also model the impact of participant cost sharing and contributions, allowing benefits managers to complete the annual budgeting process. The Experience/Migration Predictive solution is updated each year, and has the ability to store plans and scenarios for later recall and modification. Features:

• Utilizes up to three years of past claims to develop the expected medical and Rx costs for a plan

• Adjusts each year for demographic changes and plan changes

• Forecasts the expected employee enrollment for up to six current plans into a mix of plans for the next year

• Creates budget/funding rates for the following year’s plans

• Can highlight scenarios where a change of plan(s) may cost more than expected

• Integrates with Claros Analytics Actuarial Assistant


The Interface Components of the Experience and Migration Predictive solution interface:

Utility Panel The panel that runs across the top of the window. This section contains the radio buttons for selecting the various screens and the action buttons to run the functions and simulations

Input & Result Panel The main section of the screen. This is where data will be entered and output results will be displayed

Radio Buttons Radio buttons are used to a) select the screen to be displayed in the Input & Result Panel, or b) select the analysis methodology

Function Buttons Rectangular buttons used to execute calculations or simulations

Data Entry Fields Data can be entered only in the dark shaded cells in the Input & Results Panel

Experience Analysis: Inputs & Calculation

1) Experience: Inputs for the enrollment, claims experience and large claims; the stop loss specific deducible for the projection period and the dates for the experience period are also specified here.

2) Plan Setup: Input of the plan designs for the experience period and the projection period; enrollment details for the experience period are also entered here

3) Current Year Setup: Input for the contribution strategy and enrollment for the current year

4) Experience Exhibit: Output of the experience analysis; inputs are available to tailor the analysis, e.g., weighting of periods,


adjustments for changes in the area factor, provider network, or other factors

5) Finalize Experience: Function button to complete the experience analysis, normalizing the data across the experience period

Migration Prediction: Setup and Simulation

6) Setup Migration Simulation: Function button sets up the solution for the migration analysis based on the experience analysis

7) Proj Yr + Migration: Input and analysis for the migration simulation

8) Yr Y opt: Specifies that the migration simulation will model the employee enrollment migration for the current year. This is an optional analysis; it is an in-sample test that can be useful for calibrating the migration simulation

9) Yr P: Specifies that the migration simulation will model the employee enrollment migration for the projection period

10) Run Migr Sim: Function button that runs the migration simulation

Migration Methodology Selection

There are three migration simulation methodologies a user can select: - PVM: Perceived Value Methodology – simulates employees

selecting plans based on their perceived value of the plans. This is the default methodology

- OVM: Optimal Value Mythology – simulates employees each selecting the optimal plan for themselves

- MVM: Minimal Value Methodology– simulates employees each selecting the plan that has the least value for themselves

Budget Rates Calculation 11) Proj Yr Budget Rates: The solution will build budget rates based on the projected enrollment. Input stop loss rates and expenses (PEPM) and can include a manual rate to be blended with the experience rate

12) Budget Rate Margin setup: function button sets up the solution to allow the user to adjust the embedded margin in the budget rate

Solution Functions - Sim Trials: Simulation trials to be run - Archive: Function button to save the current analysis to the

archive, or recall saved cases from the archive - Print / Export: Send the current analysis to an Excel file or to a

print file - Move Y to Y-1: Shifts all data entered back one year, useful when

entering data, the following year for the same group - Reset Solution: Resets the solution, clear all inputs - Clear Migr Enroll: Resets the enrollment overrides related to the

migration simulation if a user needs to run a fresh migration simulation

- Log off: Exit, stage right


Setting Up the Solution Experience Setup The Experience and Migration Predictive solution will use up to three years of paid claims experience. The solution will

accept a minimum of 12 months, and up to 36 months, of paid claims that are divided into three 12 month rolling

periods. The solution will also recognize and adjust these periods for overlapping plan years where two plan years may

be present in an experience period. It will take into account plan designs, populations, and payment lags when making

these adjustments. All the user needs to do to set up the experience is to define when the projected plan year begins,

when the experience period ends, enter monthly claims and enrollment data, and provide details about the plans – the

solution will do the rest.

Enter the plan effective date for the projected plan year – the prior three plan year dates are derived from this date.

Enter the date of the last experience paid month – this should be the last day of the last paid month. The three 12

month rolling experience periods are determined from this date.

Enter the stop loss deductible that is planned for the Projection plan year.

Enter the monthly enrollment (total Employee counts), medical and Rx paid claims.

- If the monthly enrollment counts are not known, then the user should enter the average EE enrollment for the

Plan Year in each month of the plan year.

The solution will need employee enrollments for the number of months equal to the medical payment lag assumption

for months prior to the first claim payment month. If the user does not enter these lagged enrollments, then the

solution assumes they are equal to the first enrollment entered.

The solution assumes a three-month payment lag for medical claims and one-month payment lag for prescription drug

claims. The user can override these assumptions but must use a whole number of months (no fractional months are

allowed). The payment lag assumptions impact the trend assigned to the experience as well as the determination of the

plans (plan design RVs) and enrollments (age/gender and dependent counts) effective during each experience period. If

the claims are on an incurred basis the lag should be set to zero.

Enter large claims: The solution will present the user with a claim threshold (which is the de-trended stop loss

deductible) at the top of the column associated with each experience year. The user should enter all claims paid for an

individual (from the 1st dollar) that exceeds the large claim threshold – if claims are entered that do not exceed the large

claim threshold the solution will ignore them.

The solution has an assumption for medical and Rx trend by year – the user can override the solution’s medical and Rx

trend assumption.

The solution assumes a four tier rate structure by default; the user can override this assumption to set a three tier or

two tier rate structure. The solution also has an assumption about the ratio of each tier rate to the single rate for each

tier; the user can override the ratio assumptions, if needed. Make sure the entire override table is completed with the

entire rate tier ratio structure.


Plan Setup The Experience and Migration Predictive solution will adjust each year’s experience for changes in plan design, the

demographic content of the group, and the group’s dependent content. In addition, the solution will recognize when

experience year spans two plan years and will weigh the impact of the above factors by period appropriately.

Design Plan if it has not been done already, the medical and Rx plan designs can to be set up in Actuarial Assistant (AA) and saved to

the AA Archive or plans can be set up and saved to the archive using the AA Archive screen.

Once the plan design is complete, click the [AA Archive] button and save the plan to an archive.


When the 2) Plan Setup radio button is clicked the [AA Plans] button becomes visible. This button opens the archive for

plan designs (the path for the plan design archive (which may be an archive shared with Actuarial Assistant) can be set in

the EM’s archive window). This screen allows the user to set the plans that were available by plan year.

In order to set the plans, click the [AA Plans] button; when the AA Archive window opens select the plan to load (Step

1), then select the year (Step 2), then select the plan radio button in Step 3, and Click [Add Plan] button (the [Delete

Plan] button will remove the selected plan from the experience analysis).

Note: All plans must be selected from the same archive location


Enrollment Details Once the plans are loaded the user should fill in for the current year and the prior years:

- the number of employees enrolled in each plan

- the distribution of employees by coverage category (dependent content for the entire employee population)

- the demographic detail (either average age and percentage male, or the age/gender distribution) for the entire

employee population

- the demographic detail for the projection year.


Current Year Setup The Experience and Migration Predictive solution needs some more detailed information about the current year’s plans,

which is used in the migration algorithm. Specifically,

- the employee enrollment by plan and enrollment tier

- the employee contributions (monthly) for each plan by enrollment tier

- employer contributions (monthly) to employee savings/reimbursement accounts (if any)

- plan type: PPO, HMO, or a CDHP

- the average age and percentage male enrollment percentage for each plan.


Experience Exhibit After the current year data is entered the user can move to 4) Experience Exhibit. At this stage of the analysis, the

normalization factors have not been calculated – this is done when the [5) Finalize Experience] button is clicked. At this

point in the experience analysis the user should review the experience exhibit and enter any adjustments for the

experience period that impact the experience in a particular year that may not be different from the current period. For

example, if the group implemented an improved provider network in one of the plan years, the experience should

reflect this. Care should be taken in setting these factors in that their impact may only be present in a partial year if the

experience period spans two plan periods. If this is the case, then the factor should be reduced for this partial year

impact (consider the payment lag when determining the portion of the year the factor applies).

The experience adjustment factor should be entered as a relative value to the current plan year (denominator). For

example, if the plan implemented an improved network (e.g., 10% better discounts) then the factor should be entered

as 1.00/.90 or 1.11 since the same claims in the current year would be 10% better than the experience prior to the

improved network simply due to the improved discounts. This factor should then be entered for each of the earlier

periods where the improved discounts were not available. The solution will then divide the experience period claims by

the factor to place it on the same basis as the current year. In our improved network example where the relative factor

was 1.11 the experience claims would be reduced because if they were paid in the current year they would have been

paid under the new network discounts – we are placing the prior experience on the current year basis.

Once the factors are set for changing conditions not explicitly handled by the solution (plan design, demographics, and

dependent content) the user can run the [5) Finalize Experience] routine. In this step the solution is running all the plan

design values in order to normalize the experience for plan changes during the prior periods.

Finally, the user can review the final experience analysis and select the final weighting (or accept the solution default)

between the experience periods to finalize the experience analysis. The final Weighted per Adult Equivalent Cost is the

expected average cost per Adult Equivalent for claims under the stop loss deductible entered in the Experience Setup.

Later in the Budget Rate section, the fixed costs for Stop Loss and Administration will be added to derive the final Budget

Rates.


Adult Equivalent (AE): this is the claim cost for an adult employee. Adult equivalents are determined based on the tier

ratios set on the Experience page; by default, a spouse is assumed to be 1.2 x AE, a child is less than 1 AE; the user can

adjust the tier ratios as needed. Together, the total AEs in a group is the sum of the coverage tier ratios (to the EE) times

the enrollment in each coverage tier. The total AEs is a measure of the total medical resource consumption that reflects

the dependent content.

Enrollment Migration Prediction Projection Year + Migration Once the experience analysis is final the user must Click [6) Setup Migration Sim] to set up the migration. Once the

setup routine is complete the user should select [7) Proj Yr + Migr] to begin the migration analysis.

The migration analysis uses a simulation of the population with many rules and assumptions about employee benefit

decision making behavior to determine which plan an employee will choose when offered a number of options

regarding benefits and employee contributions for the upcoming year.

In order to begin the migration analysis, the user needs to enter the monthly employee contributions by plan and by

enrollment tier. The user can also enter monthly contributions to a savings/reimbursement account, if applicable. The

user should also set the plan type (PPO, HMO, or CDHP), and indicate if a contribution is made to an employee

savings/reimbursement account can the account be rolled over to a future period or not.

Now it is time to run the migration simulation. First the user needs to select whether they will model the migration for

the Projection Year [8) Yr Y opt)] or for the Current Year [9) Yr P]

- 8) Yr Y opt: With this radio button selected the simulation will model the employees’ enrollment into the plans

that were offered in the current period. This can be useful in evaluating how closely the solution is forecasting

enrollment behavior relative to observed behavior. A user can also use this mode to adjust the migration

calibration parameters to more closely replicate the observed enrollment.


- 9) Yr P: With this radio button selected the simulation will model the employees’ enrollment into the plans

being offered in the upcoming projection period

Once the simulation period is selected, click [10) Run Migr Sim] button to run the enrollment migration simulation. The

user must re-run the simulation [10) Run Migr Sim] each time a contribution is changed, a plan is changed, or a

calibration parameter is modified.

Migration Calibration Parameters: There are five calibration parameters that can be adjusted to enable users to obtain

the best fit of the current year enrollments; these calibration parameters can be modified to refine how the simulation

models employee enrollment:

- Group Risk Aversion / Risk Aversion by Tier: the more risk averse the participants in the group are the more

they will favor benefits over price. The risk aversion can be set globally to apply to the entire group, or by

enrollment tier, to allow for more refined modeling of employee’s behavior. This parameter is from -5 (least

risk averse) to 5 (most risk averse); the lower the number the more the population/tier will move in the

direction of a cheaper plan. Offsetting this behavior could be the internal rule regarding inertia (participants

have some tendency to stay in their current plan if it is offered) and the differential in contributions.

- Benefit Knowledge: (from 0 (least knowledgeable) to 3 (most knowledgeable) – this parameter impacts how

participants perceive the differences between plan options. The more knowledgeable a participant is

assumed to be it is assumed they will use more plan design parameters in their perception of the difference

between plan option (deductible, out-of-pocket maximum, coinsurance, copays) and how it fits in with their

current situation (i.e., claim level). The less sophisticated a plan participant is, the more likely it is that the

participant will use fewer parameters to compare plans.

- Consider a Different Plan Type: (-5 least likely, 5 most likely) – this parameter factors in the likelihood of

choosing a CDHP plan.

- Inertia: (-5 least, 5 most) – this parameter modifies the algorithm’s inertia assumption or the likelihood of a

participant remaining in their current plan if it is offered, even though it may not be in their best interest.

- Future Communication: (0 none, 3 most) – this parameter concerns the plan sponsor’s intention to

undertake a benefit communication program that will enable the participants to make more informed

decision regarding the medical plan. As this parameter increases, the ability of the participant to optimize

their own situation through their plan selection is increased.

When the migration is set for the Projection year [8) Yr Y opt], the Risk Averseness calibration parameter can be set by

current year plan in the blue data entry boxed under the heading “Override Risk Averse” to the left of the Migration

Matrix.

Cost Impact Table: the table in the upper right corner of the screen shows the expected change in benefits cost, broken

out by: Changes in Plan Cost below the Stop Loss, Changes in Employee Contributions, Changes in Savings Account

Contributions, and Net Change. The numbers will be green if the changes are expected to result in lower costs for the

plan sponsor, and red if the changes are expected to result in higher costs for the plan sponsor.

The calculation of the benefit payments is an approximation based on the plan design values of the plans and not the

risk level of the participants enrolled in each plan. In some cases, the benefit payment change could be overstated if

better risks are incentivized to move to a lower priced (less rich) plan where would then pay lower contributions while

continuing to incur few claims (the opposite effect can also happen). Implicit in the calculation of the benefit change

estimate is the assumption that migrators between plans have the same average risk as all participants who remain in

plans.

Migration Matrix: this table shows the modeled employee migration between current year plans and the upcoming year

plan options. The migration algorithm will perform the analysis by plan and coverage category but the Migration Matrix


shows the total enrollment. The table of plan design contributions will show the migration for the projection year by

coverage category.

Migration Charts: the charts show plans and enrollments for the current year and the projection year visually. The X

axis is the contribution relative value for each plan (contribution RV is for all coverage tiers combined weighted by

current year enrollment). The Y axis is the benefit relative value for each plan (benefit RV is actuarial value weighted by

current year enrollment). The size of the bubble is the enrollment in each plan. These charts are useful for visualizing

the incentive structure in terms of benefit level and price that the plan sponsor has created. Usually the plans line up

along a line with a positive slope (up to the right from lower benefit/lower cost to richer benefit/higher cost). These

charts will also illustrate the risk averseness of the participants (e.g., if they choose benefits over price).

Migration Methodology: PVM (Perceived Value Methodology), OVM (Optimal Value Methodology), MVM (Minimal

Value Methodology): By default, the solution displays the Perceived Value Methodology PVM (decisions based on the

perceived value of the differences between plan options). These are the options we expect participants will choose

given their prior decisions (current plan choice) along with their current situation (claim level), and their ability to make

decisions in their own interest by overcoming decision making biases.

When the solution runs the migration simulation it models a claim level for each participant. The solution knows for

each person how much they will spend out of pocket for cost sharing provisions in the plan as well as employee

contributions and savings account contributions. The solution also calculates the enrollment based on two additional

methodologies: Optimal Decision Methodology (OVM) and Minimal Value Methodology (MVM). When the OVM radio

button is clicked, the user will see the migration based on the employees making the best possible decision for their

current situation. It is interesting to toggle back and forth between PVM and OVM to gain insight into the group’s risk

profile (risk averseness) or their ability to optimize their decisions. The MVM radio button will show the user what the

migration would look like if the employees made the least optimal decision for themselves.

The user should always review the migration result to make sure it appears reasonable. The user can override some or

all the migration results by using the “Enrollment Override” cells in the plan table. When the scenario is archived the

final migration including overrides will be saved in the override cells so they can be retained when the scenario is

recalled at a later time (to create a new migration Click [Clear Migr Enroll] to erase the overrides – they will remain in

the archive unless the scenario is updated through the archiving window with new results).


Projection Year Budget Rates Once the user has finalized the experience derived claim cost, and has forecasted the enrollment into the upcoming

year’s plan options, they can now finalize the budget and budget rates for the plan. Select 11) Proj Yr Budget Rates to

create the budget rates. Enter the plan’s stop loss rate and expenses into the cells at the top left part of the screen. The

user can enter a manual claim cost into this table if the experience cost is not fully credible and they want to blend the

experience with a manual rate. The user can also reflect any anticipated changes in the demographic content of the

group or make other adjustments in the tables at the top of the screen.

The solution will create final budget rates for the composite plan as well as for each plan offered. The fixed costs will be

added to the claim cost and then distributed across the tiers in order to conform to the rate structure that was specified

in the Experience Setup screen. The employee contributions and savings account contributions are also shown so the

total plan cost can be calculated.

Note: the budget rates by plan are spread by actuarial value and do not reflect the risk of the option’s enrolled

participants. A final adjustment can be made to each plan’s claim cost in the “Claim Cost Adjustment Factor” to the left

of each set of plan budget rates. This adjustment is for any factor not considered by the solution in the spread of the

budget rates, or as a way for the user to create a custom set of rates. The composite set of budget rates will reflect the

adjustments made to the plan specific budget rates.

Keep in mind that the revised composite claim cost under the stop loss may not equal the starting cost when final

adjustments are made to the plan specific budget rates. This may be reasonable in a situation where the cost for a plan

is expected to be lower if the actuarial relative value is not considering a factor (e.g., Induced demand is expected to be

different than is valued). If the user adjusts one plan due to the risk status of those enrolled in the plan, then the user

may want to adjust the other plans so the expected claim cost under the stop loss is back in balance with the starting

value because in total the expected claim level is accurate but the user wants to spread the costs differently by plan.


Budget Rate Margin Setup Experience & Migration Predictive projects expected claims for any given group under the stop loss deductible. The fixed

cost for stop loss and administration are added to the claims to arrive at the budget rates. These rates are at the

expected values which are usually near the 50th percentile. If margin is added to the claim cost, the solution will return

to the user the percentile at which rates have been developed. This percentile is the confidence level that the realized

claims experience will be at the adjusted projected claims cost or lower.

User first needs to click [12) Budget Rate Margin Setup], then the user can set the margin, or define the percentile:

- Set the margin: in the input Margin % the user should enter the percentage amount by which they want to

scale up the claim level. The solution will display the resulting adjusted claim level and the confidence level

that this claim level will not be exceeded. This adjusted claim level will be included in the budget rates

- Define the percentile: in the input Percentile, the user should enter the target confidence level they want

that the claim level will not be exceeded. The solution will display the resulting adjusted claim level and the

equivalent margin percent. This adjusted claim level will be included in the budget rates

Set the Margin

Percentile of Claim Level

Adjusted Claim Level


included in Budget Rate

calculation


Define the Percentile

Margin %



included in Budget Rate

calculation


Load a Scenario Plan from the Archive Click [EM Archive] button on the main page to bring up the Archive Dialogue

Click [Select Scenario] to select the Scenario

Select the plan you want to load into the Experience & Migration Predictive tool.

Click [Load to BM] button under Base Case to load this plan as the Base Case in Experience & Migration


Archive: Saving Scenarios The archive function enables you to save plans you have built in Experience and Migration Predictive solution and recall

them at a later date.

Saving Scenarios to the Archive Once you have created a Scenario you want to save for future reference, click the [Archive] button

This will open up the Archive window

Select [Click to Add Session and Scenario Descriptors]

Session Descriptor: Top level description, may be the plan sponsor name and plan year

Scenario Descriptor: Second Level description, may be used to identify the scenario created

Created By: Scenario author

Then click the [Archive] button under Base Case to save the scenario to the archive.

NOTE: ExperModDB1.accdb should not be opened outside the Software Solution or manipulated in any way.


Export Outputs Click [Export] button on the main page

To export the output file to Excel

- Click [Set Export Directory] to designate directory path to which export file is to be saved

- Name the export file in the white box provided

- Click [Create the Export to Excel] button

- The excel file created will have tabs for the Outputs, the Inputs and the Compare Table

- To create a report, check the box [Claims: Projected and Historical] and click create the report.

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