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Actuarial/Underwriting
Key to succeeding or even ensuring viability with a Medicare+Choice program is the ability to:
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Identify high risk members.
- Stratify the membership by risk group.
- Predict future costs.
Owing to the Balanced Budget Act requirement to provide CMS with encounter data, the ability to accurately estimate future costs is becoming significantly easier and more accurate.
Plan
Data Management already provides its clients who use
our Medicare reconciliation service, E*LOG™,
the following information about their M+C membership:
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Percentage distribution by age and sex.
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Frequency distribution by age and sex.
- Age and sex comparison to fee for service Medicare.
- Overall risk score for the plan.
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Number of individuals by PIP-DxGroup.
- Rate per 10,000 by PIP-DxGroup compared to Medicare fee-for-service.
- Number of individuals by PIP-DCG.
- Rate per 10,000 by PIP-DCG compared to Medicare fee-for-service.
In addition to the above, we can also break down this data by county and even by provider group.
Copyright
© 2002 Plan Data Management, Inc. All rights reserved.
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