Wakely Risk Insights for Medicare Advantage

Wakely Risk Insights for Medicare Advantage houses two major components: The Medicare National Report & WRI-MA.

Wakely Medicare National Report

The Wakely Medicare National Report (MNR) is a retrospective member level profitability study that pinpoints an organization’s leading drivers of profitability and compares them to national benchmark data. By evaluating risk-adjusted experience from organizations across the nation, the report provides insight into past performance and opportunities to optimize future outcomes.  With this knowledge health plans can gain robust insight into the impact of legislative, regulatory, and competitive forces on their business.

An important component of the member level analysis is the allocation of key financial amounts (e.g. claims, DIR, administrative expenses, taxes/fees, Part D Risk Corridor, etc.) at the member level. Wakely then utilizes advanced statistical techniques to objectively identify profitability drivers that consider and isolate interactions between characteristics. Traditional techniques that simply look at various slices of your business fail to identify interactions of various characteristics. For example, HMO plans might appear unprofitable, but further scrutiny may show the true driver was a higher concentration of HMO enrollment existed in regions with unfavorable provider contracts. The MNR will help organizations determine the relative importance of each variable in driving overall plan profitability.

Participation in MNR study is free of charge. Wakely is currently seeking participants for the 2022 MNR. Our target schedule is below.

Participating organizations will receive the following at the conclusion of the study:

1) A report describing key patterns and drivers of profitability across the participant benchmark dataset
2) A Microsoft Excel Suite that contains key drivers of profitability for your organization and a comparison against patterns in the benchmarks
3) Organization specific HCC prevalence and recapture rates, alongside benchmark results
The Excel Suite will contain the following exhibits, all of which are dynamic and allow for viewing of aggregate organizational results, contract specific results, and plan specific results, unless otherwise noted.
Monthly Income Statement
Nodal Analysis Tree – National Data Only
Top Drivers of Profitability – Aggregate and PMPM
Experience Year Financials
Cost Model at the PBP category level
Inpatient Drill Down (DRG and MDC level)
RX Utilization and Cost Data by Tier and Ending Coverage Phase
Summary of Top 100 NDCs in National Data
Medical & RX Continuance Tables
Cohort Analysis – By Risk Model
Administrative Expense Summary
HCC Prevalence Report
HCC Recapture Report

The Nodal Analysis Tree (exhibit 2 listed above) is developed using the WRIMA Distancing Measure, a measure that determines which variables have the strongest correlation to profitability. This measure considers both the difference in profitability relative to the average and the concentration of enrollment with the given characteristic to provide a wholistic view of overall profitability impact. See the example nodal analysis tree below - note this is only an illustrative subset of the full tree that participants will receive.

node tree



Wakely also offers a paid version of this analysis known as WRI-MA. This analysis provides a deeper dive into organization specific results and is more flexible, with the ability to look at different time periods, including emerging year-to-date data.  Some of the additional benefits include:

  • Contract-PBP-Segment specific nodal analysis trees (see example graphic above)
  • Inclusion of custom variables, determined by your organization, such as: provider group assignment, member county, etc.
  • Ability to view additional member cohorts (including groupings of multiple characteristics at once, such as: DSNP members with Cardiac HCCs) for profitability comparison to the benchmark data
  • Option to receive a report displaying profitability for each of your members, including MA and PD components

Wakely consultants will help your organization understand the results and identify potential areas for further scrutiny. Fees for WRI-MA are variable depending on your organization’s involvement in other Wakely products / offerings, such as Medicare bids or the Medicare National Report. Pricing will be reduced in instances where there is overlap in the data collection efforts.

Purchase of the WRI-MA paid version is NOT required to participate in the Medicare National Report.

Please reach out to WRIMedicare@wakely.com if your organization is interested in participating, would like a demo or additional information.