Wakely Risk Assessment (WRA)

The Wakely Risk Assessment (WRA) model was developed to provide a transparent, open-code, and high performance risk assessment model. It was designed from a practitioner’s perspective, keeping in mind the typical implementation challenges and actuarial reporting needs. WRA requires basic data elements for risk assessment, elements that are captured in a relatively consistent way in administrative claim data. We focused on model reporting elements that allow for intuitive actuarial analysis, including a number of key model diagnostics that may enable detection of some of the more obvious data issues. 

WRA includes a fully developed option to run the Centers of Medicare and Medicaid Services’ (CMS) Affordable Care Act (ACA) Hierarchical Condition Category (HCC) model as well. The user can easily apply any year of the ACA model (2014+). The development team quickly incorporates updates to the HHS models (including new benefit years) and provides updates to licensed clients. 

The Wakely Risk Assessment model is able to assign risk scores to members in a simple and transparent manner. This model can risk-score members using pharmacy-only data, diagnosis-only data, or both pharmacy and diagnosis data. The CMS HHS model uses diagnosis data, or both diagnosis and pharmacy data starting 2018. The model includes both prospective and concurrent risk assessment, and can risk-score members with partial enrollment duration by applying completion factor adjustments.

The WRA model contains adjustments to reflect the relative cost differences of Medicare, Medicaid, and Commercial members. The model also includes benchmarks that allow for an easy comparison of condition prevalence across different coverage types.

The model is licensed as open-code scripts, for user’s choice of either SAS or SQL platforms. The user has complete access to all the details of the output, including the member-level array of condition markers.

Unique products and tools.

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

Request a Product Demo

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.

Get product details

Wakely National Risk Adjustment Reporting (WNRAR)

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

Get product details

Risk Score Opportunities (RSO)

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

Get product details

Wakely Plan Valuation Model (WPVM)

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

Get product details

Risk Adjustment Payment & Identifying Discrepancies (RAPID)

Gets the most out of your EDGE data.

Get product details

Wakely Analytics Health Operations Optimization (WAHOO)

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

Get product details

Wakely Affordable Care Act Competitive Analysis Tool (WACACAT)

Allows users to interactively explore market metrics.

Get product details

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.

Get product details

Wakely Risk Insight National Reporting Project (WRINR)

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

Get product details

Wakely Medicare Repricing Analysis Tool (WMRAT)

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

Get product details

Wakely ACA Database (WACA)

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

Get product details

Risk Adjustment Data Integrity Analysis & Lineage (RADIAL)

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

Get product details

Risk Adjusted Payments & Identifying Discrepancies for Medicare Advantage Plans (RAPID-M)

Helps plans optimize risk scores by identifying RAPS and EDS inconsistencies

Get product details

Ready to learn more about WRA?