Experience Analysis & ReportingWe compile and analyze client data and tailor reports to meet specific client needs. Example services include:
- Historical utilization and cost reporting for ongoing experience monitoring and identification of cost drivers;
- Utilization, unit cost, and case mix trend analysis for forecasting;
- Population service benchmarking and provider assessments;
- Contract analysis for reimbursement system accuracy testing.
IBNP EstimatesWe provide independent periodic estimates of liabilities incurred but not paid (IBNP) for health plans and self-funded employer groups to assist in statutory reserving and capital planning.
Risk AdjustmentFor health plans subject to risk adjustment, ongoing monitoring of population risk status is essential for financial reporting, capital planning, and risk revenue optimization. We can provide ongoing monitoring of risk scores under any model, suspect analysis to identify opportunities for improved accuracy of diagnosis coding, and other services related to risk adjustment.
For health plans with capitated provider networks, risk adjustment programs ensure that providers are compensated fairly based on the health risk of the populations they serve. We can review current risk adjustment programs, design programs that meet client and provider needs, assist in implementation of new or existing programs, and independently administer programs on an ongoing basis.
Medicare AdvantageWe are able to support Medicare Advantage and Prescription Drug plans in all aspects of bid development and experience monitoring, including:
- MA/PD bid development and supporting documentation;
- Desk review and audit support;
- Risk score projections, including mid-year sweep estimates, late data estimates, and suspect analysis;
- Experience monitoring including medical utilization/cost modeling, IBNP estimates, membership summaries, revenue estimates, and Part D settlement estimates;
- Market analysis and feasibility assessments.