Many provider and benefit vendors are stepping forward to unveil innovative and previously unexplored solutions to the complex challenges in the healthcare sector. A key challenge that these companies frequently face is in demonstrating their value proposition to health plans so that their services can be included as covered benefits or as care management programs. The Wakely care management and point solutions team helps payors, providers and benefit vendors evaluate their solutions to determine the impact being made on member’s health and in turn on the overall financials of these organizations.
Prospective ROI Analysis
Newer benefit vendors who have not collected data, either because their programs haven’t started yet or because they simply do not yet have data from their partner health plans, still need to demonstrate their value proposition to health plans. In these situations, we support these vendors by offering a customizable model called the Wakely Health Outcomes Benchmark and Analysis Tool (WHOBAT). This is an off-the-shelf model that combines benchmarking, expense calculations, and medical savings analysis to quantify the potential impact generated by a supplemental benefit or managed care program. The tool is fully customizable to model a specific target population and intervention. Examples of questions that can be answered with this tool include:
- How can we demonstrate the ROI that plans or ACOs could expect to realize from a particular program or intervention?
- What is the quantification of potential medical cost offsets for engaged patients or members?
- What do average medical costs look like for certain cohorts of patients or members?
Refinement of Marketing Decks to MA Plans
Wakely has provided support to vendors in developing a prospective ROI model to help demonstrate their value proposition to health plans. Using our experience working with other benefits vendors, Wakely can further assist the client in reviewing their marketing decks to make suggestions for enhancement to address the full scope of impacts that they are expected to have.
Many health plans expect their benefit vendors to take on some form of risk when negotiating contracts. Wakely can provide support to these vendors in evaluation of proposed contracts to determine what parameters and metrics are most likely to make those contracts profitable for them. Furthermore, we can help to provide guidance on structuring the contracts to be able to collect the appropriate data needed to conduct a retrospective ROI analysis.
Concerning the data, Wakely can advise on what data to request from payors including the most important fields for conducting an analysis. Furthermore, Wakely, being SOC 2 Type 2 certified, can work with the vendor’s clients to be able to directly receive the data for subsequent analysis.
Oftentimes, a comprehensive claims and medical expense analysis may need 18-24 months of post launch experience. This is required to gather claims information with enough run-out on a large enough sample of members engaged with the benefit vendor to draw meaningful conclusions. Wakely can aid in determining vendor specific data to use as a statistically relevant proxy to share results quicker.
Retrospective ROI Analysis
Wakely has assisted vendors who were able to collect data in evaluating their care management impact by conducting retrospective analyses on the data. This can include comparisons against a cohort control population, pre-post analyses, or Propensity Score Matching techniques. The best data are those from the health plan however it may be possible to leverage the VRDC database for this. Doing so will depend on the parameters of the study and whether we can identify the engaged members based on PBP status or NPI.
Wakely has a dedicated Stars team that is certified across a multitude of HEDIS measures and can evaluate those individual measures for our clients. We can advise on the impact that the benefit might have on individual Stars measures as well as advise on what a change in Star rating could mean for the health plan.
New benefit vendors develop solutions which typically target a specific population segment or high-cost condition. Wakely can provide support in developing procedures to identify targeted members who will benefit from the vendor’s solution.
Our Care Management Analysis Team
- Senior Consulting ActuaryFSA, MAAA
- Consulting ActuaryFSA, CERA, MAAA
- PrincipalFSA, MAAA, MBA
- PrincipalFSA, MAAA
- Senior Consulting ActuaryASA, MAAA
- Senior ConsultantMS, HSM
- Senior Consultant, Market & Provider Strategist
- ConsultantJD, MHA
- Consulting ActuaryASA, MAAA