Utilization Rate Estimates
Reden & Anders Utilization Rate Estimates represent utilization benchmarks that vary by region and can be adjusted on an age/gender basis. In addition, you can specify whether the benchmarks should be based on a loosely managed, moderately managed, or well-managed level of medical management. The product allows you to develop benchmark reports for inpatient, outpatient, physician, and pharmacy service categories for the various regions and levels of medical management.
Medical Expense Models
Reden & Anders Medical Expense Models are Excel-based models that allow you to develop per-member, per-month (PMPM) expense estimates on both an allowed and net basis, with the net PMPM expenses reflecting a particular benefit design option. Details regarding utilization-level assumptions and unit price assumptions per service are presented in the PMPM buildup. The Medicare version of the model reflects Medicare HMO experience data and our actuarial estimates.
Physician Specialty Medical Expense Models
The Physician Specialty Medical Expense Models develop PMPM expense estimates for services rendered by physicians. Details regarding utilization levels and unit price assumptions are presented in the PMPM buildup. You can run the models by physician specialty (e.g., allergy, cardiology, etc.) as well as commercial and Medicare populations.
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