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Wakely risk adjustment simulation dating, technical Details

Prevalence report showing proportion of member months by risk adjustment model category age, gender, and condition categories such as diabetes, asthma, etc. Detailed reports that show the key drivers behind risk scores. Guidance for estimating the pricing impact of high risk pool members and previously uninsured members entering the individual insurance market. This version will use all available information for a member in order to calculate the risk scores.

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Technical Details

Risk Score for health plan individual, small group Average risk score for state for the markets the health plan participates in individual, small group. This is expected to bias the risk scores, such that a partial year comparison will likely not hold up well as experience completes through the year.

Data provided to Wakely by health plans will not contain any financial expenditure information. Participating companies will only provide Wakely with summary level results after running the Wakely Risk Adjustment Reporting model code on their data. Wakely has implemented very strict controls and security to ensure that even the summary level results by health insurance company will not be shared. To protect the confidentiality of health plan information and to ensure that the modeling is credible, benefits of dating an ugly guy Wakely has set a minimum participation requirement.

It is important in a distributed approach to develop and review key data diagnostics. The results will be presented with sufficient detail such that pricing actuaries will be able to consider and appropriately reflect the impact of allowable rate variation due to age.

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In fact, this aggregate information is the primary reason for companies to participate in this project.

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For the reasons outlined in c above, we provide additional versions of results as described below. This process is intended to get us a better indication of the full year risk transfer. Data diagnostics to assess potential data issues early, so they can be corrected. The calculated relativity may or may not hold up well as experience completes through the year. The following notes are intended to provide a high level discussion of the proposed reports that will be returned to the participants of the project.

The only information that will be shared with other companies is aggregate results by state and market, across all health insurance companies. The result versions are described further below.