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Risk equalisation modelling
In the continued quest to improve healthcare coverage, risk adjustment has become a standard part of the insurance marketplace. Milliman consultants provide real-world expertise for complex risk adjustment applications and all aspects of the complexities of pricing and population management, including under health exchange risk adjustment programs.
Milliman Advanced Risk Adjusters ® (MARA) is a suite of risk adjustment tools for commercial, Medicaid, and Medicare population risk analysis. MARA predictive models offer unique perspectives with individual risk scores by health service categories, making them perfectly suited for budgeting, pricing, underwriting, risk stratification, and many other health insurance applications.
As a full service actuarial and consulting firm, Milliman brings a comprehensive understanding of the application of risk adjustment and predictive modelling to complex healthcare applications. Whether you require risk adjustment tools, strategic advice, or customised models, knowledgeable consultants and actuaries are always available to help design and deliver successful solutions.
MedInsight® combines vital patient information into a single, comprehensive reporting system that can accurately generate performance metrics on demand for insurers, employers, and Medicaid agencies.
Many issuers in the ACA don’t have a comprehensive risk adjustment strategy—leading to lost opportunities and less-certain financial outcomes. In this series, we provide guidance on creating a risk adjustment…
In recent years, CMS has implemented a variety of episode-based payment models. This paper provides a high-level guide to the unique and complex risk arrangements for providers under four of these models.
Quickly learn the fundamentals of risk scoring for Medicare Advantage plans, including the impact of diagnosis submission on payment timing.
Understand the benefits of shifting from location-based to functional risk adjustment in Medicaid Managed Long Term Services and Supports (MLTSS) programs.
When confronted with rising costs and shrinking reimbursement, leaders at a hospital in California took a bold step to ensure that they could continue serving the needs of the community in a financially sustainable way.
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