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Services for:
HMO's and Insurers
Providers
The Medicaid Market
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SERVICES FOR MANAGED CARE PROVIDERS
Providers and provider groups such as hospitals, physician groups, and PHO's will frequently need the assistance of an experienced health actuary in contracting with managed care organizations. Ross Health Actuarial can assist you in addressing the following needs:
- Understanding non-FFS reimbursement
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- Level the Playing Field.
- Evaluate Risks.
- Equitable pricing.
Specific services include:
- Fee schedule review and benchmarking.
- Capitation rate development and review.
- Capitation contract review.
- Development of risk-sharing arrangements.
- Stop-loss reinsurance evaluation and risk modeling under capitation arrangements.
- Utilization target development.
- Evaluation of risk-adjustment systems.
- Specialty and carve-out capitation rate development in response to offers and competitive bidding arrangements.
- Medicaid managed care contracting opportunities.
- Provider-based HMO development, including rate projections, financial analysis, and competitive studies.
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