Wakely is a leader in providing strategic advice and analytics to health plans and providers to help them succeed in the Medicare Advantage (MA) market. We bring both experienced actuaries and industry-leading tools to collaboratively and transparently solve financial challenges for our clients.
In 2019, Wakely helped 35 unique health plans to file over 600 MA and Part D bids. We have over 50 credentialed actuaries, many of whom have been filing Medicare bids for 10 years or more.
We seek to be a strategic partner with our clients and leverage our experience and products to build customized solutions. Our style is to work closely with our clients. We seek to understand our clients’ underlying company goals and business plans and in turn want to ensure that the solutions we provide are understood and accessible.
Wakely is a thought leader in the Medicare Advantage market, regularly publishing white papers, developing tools for sale and for consulting use, as well as providing feedback to CMS to improve the bidding process.
Services
Wakely has experience providing the following services:
- Medicare Bid Preparation, including MA/PD/PDP, CSNP/DSNP/ISNP/ESRD-SNP, HMO/PPO/POS/MSA
- Part D Reconciliation, including risk corridor settlement projection and LICS/CGDP/federal reinsurance Settlements
- Bid, RADV, and Financial 1/3 Audit Support
- PBM RFP Analysis, including design of RFPs and evaluation of the cost impact of PBM proposals
- MA benchmarking, including utilization and costs by service category
- Market feasibility, including projected results for expansions of a plan’s service area and for startup plans
- COA filing, including pro-forma preparation and actuarial certification of COA filings
- Risk score accrual estimates, including projected impact of mid-year, final sweeps, and encounter data submission completion
- Provider reimbursement evaluation, including cost impact of fee schedules, risk-sharing arrangements, and value based contracts
Products
Wakely can provide the following tools and products.
- WMACAT. PowerBI-based market assessment tool that intuitively allows the user to analyze MA market profiles on many different measures at the county level (Excel component included in the license enables an alternative means of county-specific deep dive analysis).
- RAPID-M. Tool that helps plans to optimize risk scores by identifying RAPS and EDS inconsistencies and estimates risk score accruals.
- Risk Score Optimization. Proprietary software tool that identifies and prioritizes those members who are most likely to have a condition that has not been coded.
- MACalc and RxCalc, Bid pricing completion tool. Facilitates accurate and efficient preparation of MA and PD BPTs.
- NABER. Wakely’s tool to help plans forecast the national average Part D bid and beneficiary premium, as well as regional low income premium subsidy amounts.
- Formulary Comparison. Excel-based tool that enables informative comparisons of competitor formulary designs.
- Part C Benchmark. Projection of C benchmark rates by star rating at the county level.
- Pro Forma. Tool that takes actuarial projections and converts them to the necessary forms required for Certificate of Authority Filings.
- MMR, PDE Processing. SAS-based tools that aggregate raw data and create user-friendly summaries of member and Part D claims data by incurred month.
- COMB. Checking tool that alerts the user to outliers or potential errors in completed BPTs.
- Stars Calculation Tool. Excel tool that provides a comprehensive look at all historical measures comprising any Medicare Advantage plan’s star rating, and framework for projecting and scenario testing future Star Ratings. Also includes measure-level detail on competitor historical performance.
- Strategic Financial Management. Financial monitoring tool that uses detailed medical, pharmacy, and eligibility data and creates comprehensive member level datasets in order to drill-down and report profitability at different levels of detail.