What We Do
We assist Medicare Advantage organizations to strategically develop products and rates to align with the specific strengths of their own business model. Our pricing teams employ flexible modeling methods allowing clients to implement the products they need to succeed. We partner with organizations beyond the pricing process to provide creative solutions to unique problems and ensure our clients optimize their market position while mitigating downside risk.
Medicare Advantage Services
Feasability studies, market entrance assistance, and pro forma development aligning with payer’s strengths.
Product design, including consumer survey driven product feature prioritization, maximizing member growth while minimizing margin impact.
Transparent and iterative pricing process that culminates in filing CMS BPTs, desk review, and audit.
Employer group pricing including Medicare Supp to MAPD conversions and RFP response strategy.
Risk Score optimization and accruals, including identification and stratification of opportunity.
Advise on total cost of care management including UM, CM, and DM design through benchmarking, ROI optimization, and market assessment.
Part D settlement and premium deficiency reserve estimates to provide insight into future receivables or payables Consulting Actuaries.
We don’t just provide service to Medicare Advantage organizations. We are strategic partners that help them take care of their people while also achieving ultimate business goals
client partnership
Critical steps in a Medicare Advantage client partnership
STEP 1 — ASSESSMENT
We begin by assessing where the business currently sits in the marketplace and determining profitability by product type.
STEP 2 — EVALUATION
Then we evaluate the client’s own goals and consider the future strategic position of their products.
STEP 3 — DELIVER PRODUCT
Finally, we develop shared assumptions and approaches, while leveraging a robust set of adaptable tools which help achieve both a competitive and profitable product.
Our tools
Element by Oliver Wyman
Our Part C pricing tool that projects Part C claims at detailed type of service category level in order to populate the Part C BPTs.
Sequence by Oliver Wyman
Seriatim model that projects and re-adjudicates Part D claims data in order to populate Part D BPTs, as well as facilitate customized analyses.
Strata by Oliver Wyman
Proprietary process for calculating CMS HCC risk scores relying on various diagnoses data.
Intercept by Oliver Wyman
Generates Part C, Part D, and combined income statement by PBP on an incurred basis.
Dimension by Oliver Wyman
Logic to map detailed medical claims into over 100 granular service categories.
Helix by Oliver Wyman
Summary of key MMR data and Rx Claim data by liability type by product.
Part C Trend development
Summarizes recent historical utilization and unit cost variations by claim service type.
PBP tool
Summarizes CMS data to determine type of service level trends.
CMS Landscape Summary
Summarizes year-over-year changes in plan offerings and premiums, and service areas.
MOOP model
Seriatim model which values the impact of the Part C MOOP.
Part D Benefits and Formulary Tool
Summarizes benefits by PBP and provides a matrix to compare formularies between two plans.
Rate Announcement Summary
Summarizes the impact of updated benchmarks and changes in Stars score.
