Medicare Advantage

Our consultants = your advantage in the Medicare Advantage market.

In the complex Medicare Advantage (MA) market, the competitive advantage goes to the health plan or provider with the clearest view of what needs to be done. Wakely consultants and expert actuaries have years of experience dealing with the MA market and closely monitor policy and regulatory developments to keep our clients up to date. Through strategic advice, analytics, proprietary tools, and comprehensive market data, we give you the edge you need to succeed.

Wakely’s Medicare Advantage Services

Our experts can assist you with:

  • Medicare Bid Preparation, including bids for prescription drug plans, special needs plans, HMOs, PPOs, and POS plans
  • Part D Reconciliation, including risk corridor settlement projection and LICS/CGDP/federal reinsurance settlements
  • Bid, Risk Adjustment Data Validation (RADV), and One-Third Financial Audit Support
  • Pharmacy Benefit Manager (PBM) RFP Analysis, including design of RFPs and evaluation of the cost impact of PBM proposals
  • MA benchmarking, including utilization and costs by service category
  • Market feasibility, including projected results for expansions of a plan’s service area and for startup plans
  • Certificate of Authority (COA) filing, including pro-forma preparation and actuarial certification of COA filings
  • Risk score accrual estimates, including projected impact of mid-year, final sweeps, and encounter data submission completion
  • Provider reimbursement evaluation, including cost impact of fee schedules, risk-sharing arrangements, and value-based contracts

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 Medicare Advantage Competitive Analysis Tool (WMACAT)

Allows health plans to compare Medicare Advantage benefits and market information at the national, state, and county levels, to evaluate plan design and performance.

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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 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 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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Wakely Plan Valuation Model (WPVM)

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

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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

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Healthcare Industry Insights

Michael CohenBy Michael Cohen
Michael CohenBy Michael Cohen