Public Sector

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.

The Reden & Anders Medical Expense Models free you from endless data overload by transforming data into timely information — information that is needed for business-critical decisions.


Flexible modeling tool

The Reden & Anders Medical Expense Models are flexible modeling tools for negotiating physician specialty service contracts; developing specialty expense budgets; evaluating bottom-line budget impacts due to changing utilization, reimbursement benefits, and demographics; calculating fee-for-service equivalents; and pricing sub-capitation and carve-out contracts.

Identify medical expense drivers

With the Reden & Anders Medical Expense Models, you can run what-ifanalyses to provide answers to key questions for your organization including:

  • What factors are driving our overall medical expense?
  • How does our budget break down by: Specialty? CPT/HCPCS code range?
  • How does our available revenue compare to expenses?
  • Are we being adequately reimbursed for the risk we are undertaking?

Benchmark commercial and Medicare utilization data

The Reden & Anders Medical Expense Models offer you the same data used by our actuarial consultants to assist in the development of physician specialty medical expense budgets. The Medical Expense Models’ utilization assumptions are supported by the Reden & Anders Utilization Rate Estimates database.

Explore financial uncertainty

Those assuming financial risk use the Reden & Anders Medical Expense Models to provide answers to the financial uncertainty inherent in physician managed care contracting.