M7:

Question 1

Process of inspecting, cleaning, transforming, interpreting, and modeling data to discover trends, patterns and other information that can be used to support benefit plan decisions and changes

Answer 1

Data Analytics

Question 2

Statistical technique used to forecast future behavior by analyzing historical and current data

Answer 2

Predictive Modeling

Question 3

To quantify risk/costs for individuals and groups in health plans

Answer 3

Uses of predictive modeling

Question 4

Involves outcomes that are partly due to chance

Answer 4

Regression to the mean

Question 5

How intensively plans use physician visits and hospitals

Answer 5

Consumption

Question 6

What plan sponsors in a self-funded arrangement contract are called, often either with a TPA or insurance carrier

Answer 6

Administrative Services Only (ASO)

Question 7

Health plan trends show there has been increased enrollment and
savings in this type of account

Answer 7

Health Savings Accounts (HSAs)

Question 8

Health plan trends show there has been increased participation in this type of health plan

Answer 8

High Deductible Health Plans (HDHPs)

Question 9

Visualization Layer

Answer 9

Analytics solutions

Question 10

Data collected in spreadsheets and databases

Answer 10

White space data

Question 11

The number of levels in the Healthcare Analytics Adoption Model

Answer 11

Eight

Question 12

Level 3 of the Healthcare Analytics Adoption Model

Answer 12

Automated Internal Reporting

Question 13

This ensures a plan has been set up properly

Answer 13

Transitional audit

Question 14

Audit procedures associated with plan enrollments

Answer 14

Operational Plan Audits

Question 15

Suggested frequency of administrative plan audits

Answer 15

Every 3 to 4 years if it is the same plan sponsor

Question 16

Typical cost of a plan audit

Answer 16

$25,000 to $50,000

Question 17

Definition of a plan’s disease burden

Answer 17

Health Status

Question 18

Level 7 in the Healthcare Analytics Adoption Model

Answer 18

Clinical Risk Intervention and Predictive Analytics

Question 19

Metadata repository

Answer 19

Vendor provides repository with analytics solutions

Question 20

Plan sponsors assume risk and liability for uncertain health care
costs

Answer 20

Self-funded plans

Question 21

Why do companies choose self-funded health insurance plans over fully insured plans?

Answer 21

Over the years, organizations have steadily moved from fully insured plans to self-insured plans to have the opportunity to lower health care costs and to be able to have more flexibility in plan design.

Study Guide, Module 7, Page 17, Learning Outcome 4.1

Question 22

What are the differences between the types of plan audits?

Answer 22

a. Transitional audit – ensures a plan has been set up appropriately when moving from one carrier to another
b. Operational audit – looks at procedures associated with enrollment such as card processing and customer standards
c. Reinsurance audit – discovers charges that should have been paid by the reinsurance carrier, but were not

Study Guide, Module 7, Page 20, Learning Outcome 4.10

Question 23

What is the difference between predictive modeling and data analytics?

Answer 23

Predictive modeling is a statistical technique used for forecasting purposes such as future outcomes. Data analytics uses a process to inspect, clean, transform, and model data to discover trends that can aid in benefit plan decisions.

Study Guide, Module 7, Page 6, Learning Outcomes 1.1 and 1.2

Question 24

Variables that can most likely influence future results

Answer 24

Predictors