Actuarial estimates
The actuarial estimates for each market or service area are based on a model which summarizes the historical experience of the target populations from the CMS 5% Sample database. The data will be presented in an actuarial model format which includes utilization per thousand rates, average allowed unit costs, and pmpm costs.
Value
- Develop estimates of market enrollment, administrative costs, and medical expenses
- Forecast financial outcomes
- Project financial implications for new products
Adjustable historical
The historical cost levels can be adjusted for: expected demographics of enrollees, trend, anticipated provider reimbursement as a percentage of Medicare, utilization/care management savings, member cost sharing, if applicable, and additional costs for benefits not covered by Medicare. The corresponding MA revenue is based on the same population assumptions underlying the cost estimates.
Pro forma projections
Our pro forma projections also rely on other proprietary Reden & Anders tools such as our market projection tools, comprehensive multi-dimensional financial projection tools, and actuarial models. We incorporate other pertinent analyses to develop estimates of market enrollment, administrative costs, medical expenses, and the resulting financial outcomes.
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