|
|
Cost and Utilization Analysis Solutions |
| Our Cost and Utilization Analysis services and tools can help you determine the right incentives to achieve appropriate utilization and effective cost controls. |
|
|
Services & Tools:
|
Actuarial Consulting
|
|
Our actuarial consulting services help you predict and manage business risks, match revenues and expenses, and forecast demand. We help negotiate risk-adjusted contracts and develop products, services, and delivery systems. |
| |
|
|
|
Actuarial Toolbox
|
|
Reden & Anders built a strong reputation in the health care industry by developing sophisticated tools and models that deliver value-added services to our clients. These tools are packaged together in the Reden & Anders Actuarial Toolbox™. |
| |
|
|
|
Benchmark Utilization Data
|
|
With benchmarking tools that evaluate your data against national, regional, and industry statistics, you can better manage costs, design more equitable reimbursement contracts, drive performance improvements, and identify opportunities to boost quality of care. |
| |
|
|
|
Benefit Plan Pricer
|
|
The Reden & Anders Benefit Plan Pricer was developed to provide users with a quick way to evaluate the differences between several deductible and coinsurance plan design options. |
| |
|
|
|
Contract Rate Model
|
|
Reden & Anders helps you to calculate the average contract size (members per contract) and the average age-gender factor by contract type based on the inputted distribution of employees by age-gender-contract cohort. |
| |
|
|
|
Drug Pricing Model
|
|
The Reden & Anders Drug Pricing Model provides users with the ultimate tool for evaluating the impact on net prescription drug expense. This model develops per-member-per-month (pmpm) expense estimates on both a gross and net basis by re-adjudicating actual claims. |
| |
|
|
|
Excess-of-Loss Rating Model
|
|
The Reden & Anders Excess-of-Loss Rating Models develop excess-of-loss premium rates for various populations with two tools; the Hospital Model calculates rates for hospital-only and global coverages and the Physician Model calculates rates for professional coverages. |
| |
|
|
|
Medical Expense Model
|
|
The Reden & Anders Medical Expense Models provide users with the ultimate tool for developing forecasts of per member per month (PMPM) medical expenses under a multitude of assumptions. Payers and providers alike will appreciate the flexibility in assessing changes in specialty medical expense budgets due to changing utilization, reimbursement, benefits, and population demographics. |
| |
|
|
|
Medical Pricing Model
|
|
The Reden & Anders Medical Pricing Model provides the user with the ability to project net covered medical expenses (after member cost sharing) and develop benefit plan relativities for complex benefit structures. |
| |
|
|
|
Payer Consulting
|
|
We help health plans—payers, insurance companies, managed care organizations—develop targeted strategies that more effectively attain financial goals and manage business risks, strategies that also improve medical cost structures, business operations, product development, provider contracting, and business information systems. |
| |
|
|
|
Pricing and Underwriting
|
|
The expertise of our underwriting consultants is supported by an arsenal of rules-based tools and forecasting and pricing models that boost the efficiency, effectiveness, and results of underwriting and rating. Broad services include operational reviews, pricing and management, risk analysis, and numerous analytical tools for rating individuals and groups. |
| |
|
|
|
Provider Contracting Analysis
|
|
Reden & Anders experts can assist you with provider profiling and credentialing in conjunction with selective contracting of providers from networks to give your enrollees access to high quality treatment at competitive costs. |
| |
|
|
|
Rating Development
|
|
The expertise of our underwriting consultants is supported by an arsenal of rules-based tools and forecasting and pricing models that boost the efficiency, effectiveness, and results of underwriting and rating. Broad services include operational reviews, pricing and management, risk analysis, and numerous analytical tools for rating individuals and groups. |
| |
|
|
|
Reserve Development Consulting
|
|
Reden & Anders can assist you with product pricing and appropriately evaluating future risks. Estimating future claim payments are essential for accurately measuring progressive’s underwriting profit and for determining whether pricing changes are needed to achieve your underwriting target. |
| |
|
|
|
Risk Management Consulting
|
|
Risk management is a major part of your business. Yet the risks are greater than ever in today’s health care delivery system. Negative care and cost results are increasingly possible. |
| |
|
|
|
Underwriting Consulting
|
|
The expertise of our underwriting consultants is supported by an arsenal of rules-based tools and forecasting and pricing models that boost the efficiency, effectiveness, and results of underwriting and rating. |
| |
|
|
|
Utilization Rate Estimates
|
|
The Reden & Anders Utilization Rate Estimates is one of the most complete database of geographically adjusted, managed care medical services utilization rates available. |
| |
|
|
|
|
|
Questions?
To discuss how we can help your organization, please contact us:
.gif)
info@reden-anders.com or
(800) 765-6042 |
|
|
|
|
|
|
