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
Rate advocacy 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 rate advocacy support available through trade associations. For individual plans, we can offer more support, including:
- Traditional actuarial services (e.g. IBNR, opinion, etc.)
- State rate negotiation strategy support
- Actuarially sound capitation rate certification for competitive bid processes
- Provider contracting and alternative payment model evaluation
- Ongoing tracking and measurement of financial results
- Assistance with state and other financial reporting requirements
- Market entry support including network modeling, RFP review, etc.
Proprietary analytic tools
Wakely has also partnered with our Data Analysis Resource Team (DART) to develop specific tools that can be customized 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
- Strategic use of Virtual Research Data Center licenses to provide benchmarks and other competitive insights
- Network analysis and optimization
- Dual dashboards for market capture
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.
- Medicaid Expansion: Data-driven Insights into Healthcare Needs
- 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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