Our Services
Since 1996, HealthCare Analytics has been serving a broad range of clients including Self-Insured Employers; Hospitals and Hospital Systems; Public Entities; Managed Care Organizations; and Provider Networks such as Accountable Care Organizations and Accountable Entities.
Actuarial Services
HealthCare Analytics’ Actuarial Services include:
- Health Plan Development & Pricing
- Rate Development
- Rate Filings
- Analysis & Development of Cost & Utilization Trends
- IBNR Development
- Reserve Calculation
- Development & Evaluation of Capitation Rates
- Actuarial Certifications & Opinions
- Development of Rating Methodologies
- Financial Projections & Proforma Analysis
- Development of Actuarial Values for Benefit Differentials
- Development of Actuarial and Pricing Models
- Development of Cost-Effectiveness Tests for Title XXI and Section 1115 Waiver Programs
Analytic Services
HealthCare Analytics’ Analytic Services include:
- Review and Analysis of Cost and Utilization Statistics By Major Diagnostic Groupings and Demographic Characteristics
- Development of Cost and Utilization Patterns and Trends
- Development of IBNR Factors and Trends
- Assessment of Demographic Differences and Ethnic Composition by Various Market Segments
- Evaluation of Market Characteristics By Industry
- Profiling of Provider Cost and Utilization Statistics Across Provider Groups and Provider Specialties
- Financial Analyses – Pro-Forma, Break-Even, Cost/Benefit
Auditing Services
HealthCare Analytics’ Auditing Services include:
- Review & Analysis of Claims Extract Files
- Development of Proportionate Stratified Random Statistical Samples
- Review of IBNR Factors
- Elibibility Testing
- Other Carrier Liability Testing
- Reimbursement Accuracy
- EOB Review
- Out-of-Area / Out-of-Network Claims Review
- Delineation of Systemic vs. Ad-Hoc Errors
- Extrapolation of Sample Errors to Population
Product Development / Benefit Pricing
HealthCare Analytics’ Product Development and Benefit Pricing Services include:
- Development of Benefit Components Within Regulatory Requirements, Guidelines and Mandates
- Pricing of Benefit Components Based on Network Agreements and Composition
- Development of Actuarial Values
- Pricing of Product Composite
- Development of Market Segmentation and Rating Methodologies
- Development of Rates Within Varying Tier Structures
- Development of Premium Assistance “Rates” for Title XXI Section 1115 Waiver Programs
- Preparation and Submission of Rate Filings and Documentation
Provider Relations & Reimbursement Evaluation
HealthCare Analytics’ Provider Relations and Reimbursement Services include:
- Assessment of Adequacy of Reimbursement Arrangements, Including:
- Percent of Permium
- Fixed Fee
- Global Capitation
- Risk Sharing
- Per Diem
- Per Case
- Fee Schedules / RBRVS
- Case Mix Analysis of Target Population/Experience
- Evaluation of Financial Exposure
- Break-Even & Pro-Forma Analysis
- Development of Risk Corridors and Risk Sharing Arrangements
- Development of Actuarially Sound Financial / Reimbursement Arrangement
Market & Competitive Analyses
HealthCare Analytics’ Market Study & Competitive Analysis Services include:
- Analysis of Rate Filings
- Analysis of Insurer NAIC Financial Filings
- Monitoring and Evaluation of Filed Cost and Utilization Trends
- Market Share Analysis of Commercial, Medicare and Medicaid Populations
- Assessment of New Product Developments
- Reserve Analysis
- Fiancial Analysis and Performance Evaluation of Health Plans
HealthCare Analytics 