Medicaid Managed Care
Teamwork makes Medicaid Managed Care work.
When Medicaid Managed Care health plans need support, they turn to Wakely’s expert actuaries and consultants. We collaborate with Medicaid health plan trade associations as well as member plans. By providing data-driven insights into member characteristics, rate development, and more, we help Medicaid Managed Care plans manage greater success.
Wakely’s Medicaid Managed Care Services
Support for plans through trade associations
Wakely has extensive experience teaming up with state Medicaid Associations and the underlying member plans. We guide both parties by:
- Providing unbiased actuarial support during the rate-setting process
- Tracking emerging trends and programmatic changes impacting their experience
- Meeting with state actuaries
- Performing a detailed review of all rating documents and assumptions
- Analyzing the appropriateness of the assumptions and technical accuracy of the rate development process
- Raising awareness of potential rating issues or programmatic challenges not addressed in rate setting
- Helping member plans design analyses that aggregate plan data while maintaining confidentiality of individual plan information
- Providing member plans with program-wide insight into population and benefit changes, programmatic trends, financial performance, and the reasonability of actuarial assumptions
Individual plan support
Our actuaries and consultants also partner with individual plans to provide much of the same support available through trade associations, such as:
- Capitation rate review and support
- State rate negotiation strategy development
- Assistance with modeling to support a competitive bid process
- Provider contracting and alternative payment model evaluation
- Ongoing tracking and measurement of financial results
- Assistance with financial reporting requirements
Proprietary analytic tools
Wakely has developed specific tools to support strategic financial management tactics, such as:
- Drill-down reporting on alternative payment model results, loss ratios, service category level trends, actual-to-expected results, and risk scores
- Development of financial pro forma, including identification of potential loss drivers related to changes in state rate-setting assumptions
Our latest reports on Medicaid Managed Care topics
Wakely is a thought leader in the Medicaid Managed Care space. Read our most recent reports below, and find more on our Insights page.
- Concentration of Specialty Services in Medicaid Provider Networks
- CDPS+Rx v7.1 Update Review
- Medicaid Unwinding: Wakely Survey of Capitation Rate Approaches for Emerging Experience
- Medicaid Unwinding: Wakely Survey of Rate Adjustment Approaches for Changing Acuity
- Medicaid Profitability During the Public Health Emergency
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