Public Sector

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.

The Reden & Anders Medical Pricing Model frees you from endless data overload by transforming data into timely information — information that is needed for business critical decisions.

Flexible modeling tool

The model is updated annually based on recent utilization and unit cost data. Also, the model is Excel-based, allowing ease of output transfer to other spreadsheets.

Key features:

  • Reden & Anders benchmark utilization underlies the calculation engine and provides variation by Metropolitan Statistical Area (MSA);
  • MSA charge levels and area Medicare RBRVS payment levels are integrated in the Model as a base for unit cost/reimbursement level development;
  • The Model adjusts utilization expectations based on input demographics (i.e., younger/older mixes or early retirees can be modeled);
  • The Model allows for combinations of HMO-like and major medical benefit structures that can vary by detailed medical service category;
  • Actual program experience can be blended with Model results; and
  • Results can be projected using a variety of employee/dependent tier options along with the base per covered member per month basis.

Benchmark commercial utilization data

The Reden & Anders Medical Pricing Model offers you the same data used by our actuarial consultants to assist in the development of pricing and management of health insurance products. The Model is supported by the Reden & Anders Managed Care Utilization Rate Estimates (MCURE™) database.

Benefits of the MCURE database

Using MCURE provides for utilization rates in detailed service categories; adjustments to reflect regional variations in utilization; adjustments for the age and gender of the population being modeled; and adjustments for the level of medical management inherent in the program being modeled.