// . //  Healthcare // Medicare Advantage

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

We begin by assessing where the business currently sits in the marketplace and determining profitability by product type.

Step 2

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

We provide customized actuarial services and strategic insight, supporting clients as they strive to exceed their business objectives. Our exceptional client and employee retention exemplifies our commitment to relationships built on trust, responsiveness and clear communication. Our clients can further capitalize on Oliver Wyman’s services through our partners at Marsh McLennan Companies: Marsh, Mercer and Guy Carpenter — world leaders in insurance and risk management consulting.

Who We Are

who we are
Our people