Common use of Comparisons Clause in Contracts

Comparisons. Historical trends should not be used in a simple formulaic manner to determine future trends; a great deal of actuarial judgment is also needed. We did not explicitly rely on the historical MCP encounter data trend projections due to anomalies observed in the historical trend data. Because of changes in contracted MCPs effective July 1, 2013, we believe encounter data between contract periods may be influenced by patterns in individual MCP encounter data reporting practices. We referred to the sources listed in the prior section, considered changing practice patterns, the impact of reimbursement changes on utilization in the MMC population, and shifting population mix.

Comparisons. Historical trends should not be used in a simple formulaic manner to determine future trends; a great deal of actuarial judgment is also needed. We did not explicitly rely on the historical MCP encounter data trend projections due to anomalies observed in the historical trend data. Because of changes in contracted MCPs effective July 1, 2013, we believe encounter data between contract periods may be influenced by patterns in individual MCP encounter data reporting practices. We referred to the sources listed in the prior section, considered changing practice patterns, the impact of reimbursement changes on utilization in the MMC population, and shifting population mix. Explicit adjustments were made outside of trend to reflect all recent or planned changes in reimbursement from the base period to the rating period.

Comparisons. Historical trends should not be used in a simple formulaic manner to determine future trends; a great deal of actuarial judgment is also needed. We did not explicitly rely on the historical MCP encounter data trend projections experience due to anomalies observed in the historical trend data. Because of changes in contracted MCPs effective July 1, 2013, we believe encounter data between contract periods may be influenced by patterns in individual MCP encounter data reporting practices. We referred to the sources listed in the prior section, considered changing practice patterns, the impact of reimbursement changes on utilization in the MMC population, and shifting population mix. Explicit adjustments were made outside of trend to reflect all recent or planned changes in reimbursement from the base period to the rating period.