ACA Services

Products and services that add up to success in the ACA Marketplace.

Wakely offers in-depth knowledge and expertise in commercial markets. We help our clients succeed through high-quality analytic work, assessment of strategic options, creative problem solving, and clear communication and documentation of complex issues.

Our services and product solutions can assist a broad set of stakeholders, including:

  • Issuers currently in the market (both large and small)
  • Issuers seeking to enter the commercial market or expand their footprint
  • State and federal regulators
  • Advocacy groups
  • Providers

Wakely has performed the nation’s only study of its kind to understand the drivers of profitability (and losses) in the ACA markets. We have proprietary claims and enrollment data sets that enable us to bring unique data-driven insights to strategy conversations.

Wakely’s ACA services

  • Industry intelligence
  • Market assessment
  • Financial planning and analysis
  • Licensure applications, pro forma modeling, QHP applications
  • Premium rate-filing development
  • Modeling benefit designs
  • Assessment of policy change impact   
  • Risk adjustment projections
  • Evaluation of provider contract reimbursements 
  • Regulatory rate-filings and objection responses
  • Assessment of competitive landscape
  • Competitor profitability analysis and projection of competitor rate increases
  • Assessment of profitability drivers
  • Market trends based on national data
  • Industry benchmarks
  • Insights from policy analysts on emerging regulations (for example, our Week in Washington blog)
  • Actuarial analysis of policy impact on premiums and profitability
  • ACA rate-filing review for states
  • Assistance with state and federal regulators to evaluate ACA policy change impacts, file 1332 waivers, and assess other potential policy changes
  • Estimation of risk adjustment transfers and accruals for year-end opinions, financial monitoring, and premium rate projections
  • Identification of discrepancies in External Data Gathering Environment (EDGE) data and reporting
  • Supplemental and chart chase efforts
  • Reports on gaps and recapture opportunities
  • Analysis of financial drivers
  • Portfolio strategy
  • Due diligence
  • Post-close integration
  • Growth optimization
We back your strategies with a wealth of data.

We back your strategies with a wealth of data.

Wakely consultants draw on a broad range of data sources to assist you in market analysis, benchmark development, strategy, and more. Here are just a few:

  • Medicare 100% Research Identifiable File
  • Medicare Limited Data
  • Wakely Medicare Advantage Aggregate Client Data
  • Wakely ACA
  • Large Group Commercial Data

Unique products and tools.

Wakely has developed these industry-leading products and tools, which empower our clients to make highly informed strategic decisions.

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Wakely ACA Database (WACA)

Contains the most robust and detailed ACA data available in the industry.

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Wakely National Risk Adjustment Reporting (WNRAR)

Provides risk adjustment metrics from 35 states and 19 million lives.

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Risk Score Opportunities (RSO)

Identifies and prioritizes members who are most likely to have a condition that has not been coded.

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Wakely Plan Valuation Model (WPVM)

Supports pricing, mental health parity compliance, cost and utilization analysis and more.

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Risk Adjustment Payment & Identifying Discrepancies (RAPID)

Gets the most out of your EDGE data.

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Wakely Analytics Health Operations Optimization (WAHOO)

Helps payers and providers optimize financial performance with a complete package of services and tools.

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Wakely Affordable Care Act Competitive Analysis Tool (WACACAT)

Allows users to interactively explore market metrics.

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Wakely Risk Assessment (WRA)

Provides a transparent, open-code, high-performance risk assessment model.

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Wakely Risk Insight (WRI)

Includes two major components: The Medicare National Report (MNR) and WRI-MA. Both pinpoint drivers of profitability and compare them to national benchmark data.

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Wakely Risk Insight National Reporting Project (WRINR)

Identifies key profitability drivers for the individual and small group markets.

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Wakely Medicare Repricing Analysis Tool (WMRAT)

Aids the comparison of payment rates across multiple lines of business, categories of service, geographic locations, and providers.

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Risk Adjustment Data Integrity Analysis & Lineage (RADIAL)

Compares multiple data sources to provide transparency in risk score differences.

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Ready to connect with a Wakely expert?

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Healthcare Industry Insights

weekinwashington1
Michael CohenBy Michael Cohen
weekinwashington1
Michael CohenBy Michael Cohen