The Wakely Risk Assessment (WRA) model was developed to provide a transparent, open-code, and high performance risk assessment model. It was designed from a practitioner’s perspective, keeping in mind the typical implementation challenges & actuarial reporting needs. The model requires basic data elements for risk assessment, elements that are captured relatively consistently in administrative claim data. We focused on model reporting elements that allow for intuitive actuarial analysis, including a number of key model diagnostics that may enable detection of some of the more obvious data issues.
The model includes a fully developed option to run the Centers of Medicare and Medicaid Services’ (CMS) Affordable Care Act (ACA) Hierarchical Condition Category (HCC) model as well. The user can easily apply any year of the ACA model (2014+). The development team quickly incorporates updates to the HHS models (including new benefit years) and provides updates to licensed clients.
Flexibility and Transparency
The Wakely Risk Assessment (WRA) model is able to assign risk scores to members in a simple and transparent manner. The WRA model can risk score members using pharmacy-only, diagnosis-only data, or both pharmacy and diagnosis data. The CMS HHS model uses diagnosis data, or both diagnosis and pharmacy data starting 2018. The model includes both prospective and concurrent risk assessment. The model can risk score members with partial enrollment duration by applying completion factor adjustments.
All Lines of Business
The WRA model contains adjustments to reflect the relative cost differences of Medicare, Medicaid, and Commercial members. The model also includes benchmarks that allow for an easy comparison of condition prevalence across different coverage types.
Choice of Platform
The model is licensed as open-code scripts, for user's choice of either SAS or SQL platforms. The user has complete access to all the details of the output, including the member-level array of condition markers.
Next Step
For more information on WRA or to request to see a sample report/demonstration, please contact Products@Wakely.com.