We have some of the best actuarial minds in the country and we realize that changing demographics, new laws and regulations, and increased competition from new competitors in the market add to the challenge of developing and competitively pricing successful health coverage. Our high consultant-to-client ratio allows us to focus on work products that meet your goals.
Accountable Care Organization (ACO) Data Analytic Support
We can provide data analytic support for ACOs using the CMS Medicare Shared Savings Program (MSSP) data. These analytic reports include, but are not limited to: CMS HCC risk scores; identifying members with chronic conditions; identifying high cost beneficiaries; identifying beneficiaries with high utilization; IBNR analysis; and beneficiary-provider matching to maximize care management programs. In addition, we can assist in the evaluation and negotiation of ACO contracting with payor organizations for both Medicare and Commercial populations. Our extensive background in Medicare Advantage and Commercial rate filings make us an ideal candidate to evaluate these contracts.
We have experience preparing and submitting filings in a number of states. In addition, we have major medical rate review regulatory experience. We can prepare, file and review rate filings.
Affordable Care Act (ACA)
We are current on the requirements outlined in the ACA. We can provide consultation on the impact of the ACA on the individual and small group markets, new rate review guidelines required by the ACA and data collection protocols to track multi-year metrics.
Medicaid Managed Care Rate Setting
We can develop Medicaid managed care capitation rates. Not only have we developed capitation rates for health issuers in a bidding environment, but we also have experience working on behalf of State Medicaid agencies (both as a state employee and as consultants to states).
We are qualified to issue statements of actuarial opinion with regard to loss reserves, actuarial liabilities and related items.
Unpaid Claim Liabilities
We can prepare monthly, quarterly, bi-annually and year-end unpaid claim liability estimates.
We can estimate the impact of ad-hoc requests, including but not limited to: legislative changes, benefit design changes, member movement and fee schedule changes.
Trend Analytics and Reporting Packages
We can develop historical reporting packages, trend analytic models and other tools useful in staying informed on emerging experience.
Pricing Model Development
We can develop pricing models tailored to meet issuer-specific needs.
Medicare Advantage Part C and Part D
We have extensive Medicare experience. We can provide the following: Medicare Advantage Part C and Part D bid preparation; training and education; and assistance with bid review to ensure all underlying assumptions are not only reasonable but also meet appropriate guidelines, instructions and preferred methodologies.
We can process, reconcile and summarize claim-level data for the purposes of developing historical reporting packages, trend analytic tools and pricing models.
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