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.

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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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 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 Risk Assessment (WRA)

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

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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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Healthcare Industry Insights

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Michael CohenBy Michael Cohen
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Michael CohenBy Michael Cohen