Our actuaries and consultants have significant experience assisting Medicaid health plans both individually and through state trade associations. We have collaborated with stakeholders in numerous state Medicaid programs to support their participation in managed Medicaid programs covering populations including traditional Medicaid, ACA expansion, and managed long-term services and supports.
Trade Association Support
Many states have Medicaid health plan associations who provide legislative and policy support to participating plans. Wakely has extensive experience partnering with state Medicaid Associations, and the underlying member plans, to provide unbiased actuarial support throughout the rate setting process. We engage with state Associations and member plans to track the emerging trends and programmatic changes impacting their experience. Through participation in meetings with the state and their actuaries, detailed review of all rating documents and assumptions, and discussions with the Association and member plans, we comprehensively analyze the appropriateness of rate setting assumptions and review the technical accuracy of the rate development process. When appropriate we work constructively with the state and their actuaries to raise awareness of potential rating issues or programmatic challenges not addressed in rate setting. As an outside entity, Wakely collaborates with member plans to design analyses that aggregate plan data while maintaining confidentiality of individual plan information. Through data aggregation projects, we are able to provide member plans with program-wide insight into numerous areas including population and benefit changes, the evaluation of programmatic trends, the tracking of program financial performance, and the reasonability of actuarial assumptions made by the state’s rate setting actuaries. Through their participation in these aggregated analyses, member plans are able to gain a broader programmatic perspective than is available in their own data.
Individual Plan Support
Our actuaries and consultants also have significant experience partnering with individual Medicaid plans to provide much of the same support that is available through trade associations. Our services support the full spectrum of managed Medicaid practice ranging from new market evaluation to ongoing reporting and analytics to valuation. This includes capitation rate review and support, state rate negotiation strategy development, assisting plans with modeling to support a competitive bid process, provider contracting and alternative payment model evaluation, the ongoing tracking and measurement of financial results, and financial reporting requirements. We have developed specific analytic tools to support comprehensive strategic financial management, including drill-down reporting on alternative payment model results, loss ratios, service category level trends, actual to expected results, and risk scores. We also have high-level management tools to develop financial pro forma, including identification of potential loss drivers related to changes in state rate setting assumptions.
As you may know, the State of North Carolina has, for the first time ever, released a RFP soliciting managed care plans to bid on covering Medicaid beneficiaries statewide. With over 1.5 million beneficiaries eligible for Managed Medicaid, this represents an unprecedented opportunity for managed care organizations in North Carolina.
This brief summarizes what the State has published and describes how Wakely can help answer the following questions:
- What are the most important factors for winning a bid?
- Are the proposed rates appropriate for your organization?
- If I win, what will it take to ensure profitability?
- How can I assess potential managed care savings?
- How is a Medicaid population different from Commercial/ACA or Medicare?
- How will risk adjustment work, and what do I need to do to ensure that risk adjustments are appropriate?