Medicare

Wakely is a leader in providing strategic advice to health plans and providers to help them succeed in the Medicare Advantage (MA) market. We bring both experienced actuaries and industry-leading tools to collaboratively and transparently solve financial challenges for our clients. 

In 2017, Wakely helped 30 unique health plans to file over 375 MA and Part D bids. We have over 50 credentialed actuaries, many of whom have been filing Medicare bids for 10 years or more.

We seek to be a strategic partner with our clients and leverage our experience and products to build customized solutions. Our style is to work closely with our clients. We want to understand our clients’ underlying company goals and business plans and in turn want to ensure that the solutions we provide are understood and accessible. 

Wakely is a thought leader in the Medicare Advantage market, regularly publishing white papers, developing tools for sale and for consulting use, as well as providing feedback to CMS to improve the bidding process.

Services

Wakely has experience providing the following services:

  • Medicare Bid Preparation, including MA/PD/PDP, CSNP/DSNP/ISNP/ESRD-SNP, HMO/PPO/POS/MSA
  • Part D Reconciliation, including risk corridor settlement projection and LICS/CGDP/federal reinsurance Settlements
  • Bid and RADV Audit Support
  • PBM RFP Analysis, including design of RFPs and evaluation of the cost impact of PBM proposals
  • MA benchmarking, including costs by service category
  • Feasibility, including projected results for expansion of service area and for startup plans
  • Risk score accruals, including projected impact of mid-year, final sweeps, and EDPS completion
  • Provider reimbursement, including cost impact of fee schedules and risk-sharing arrangements
  • COA filing, including pro-forma preparation and actuarial certification of COA filings

Products

Wakely can provide the following tools and products. 

  • RAPID-M, which helps plans to optimize risk scores by identifying RAPS and EDPS inconsistencies and estimates risk score accruals
  • MACalc and RxCalc, which facilitates accurate and efficient preparation of MA and PD BPTs
  • NABER, which forecasts the national average Part D bid and beneficiary premium.
  • Formulary Comparison, which enables intelligent comparisons of competitor formulary designs
  • WMACAT, which provides key MA market data at the county level
  • Part C Benchmark, which estimates future Part C benchmark rates at the county level
  • Pro forma, which facilitates the pro forma required for Certificate of Authority Filings
  • MMR, PDE Processing, which aggregates raw data by incurred month and creates additional information needed for reconciliations
  • COMB, which checks BPTs for outliers and potential errors

 

Interested in working with us?