Actuarial Services
Cirdan’s actuaries have years of experience working with Medicare, Medicaid, individual, small group, large group, self-funded and stop-loss products. Giving us the expertise to guide you through pricing, valuation, contract negotiations, risk adjustment, provider reimbursement and underwriting.
We also provide a broad range of actuarial services for our clients. In many cases, Cirdan provides all of the actuarial services required by its health plan clients. This includes supporting health plan executives on actuarial issues and serving as their outsourced department. Examples of typical engagements include:
Valuation of Actuarial Liabilities and Assets
We assist our clients with the valuation of actuarial liabilities and assets. This includes providing monthly valuation services, the annual Actuarial Opinion and Memorandum required for statutory reporting and acting as Appointed Actuaries for our clients. Our services help clients evaluate:
- Incurred, but unreported claims
- Premium deficiency reserves
- Risk adjustment settlements
- Medicare Part C and D settlements
- Provision for adverse deviation
Medicare Advantage Bids
Cirdan partners with health plans to support their Medicare Advantage product lines. We have worked extensively with special needs plans (SNPs) serving Medicare/Medicaid dual-eligible populations which often offer non-traditional benefits. Services we provide include:
- Monitoring CMS for regulatory changes
- Competitive analysis and bid strategy
- Data analysis
- Plan Benefit Package entry
- Administrative cost modeling
- Bid Pricing Tool modeling
- Desk review questions following bid submission
- Audit support
Medicare Bid Support For Smaller Plans
We also provide additional customized support for Medicare bids, including:
- Bid-Integrated Data Warehouse: Cirdan’s data warehouse model connects claim-level medical expenses to the complex service categories required for Medicare bids. This enables us to work efficiently with raw claims data to develop a customized medical expense.
- Administrative Expense Tools: Cirdan’s administrative expense model incorporates plan-specific adjustments based on recent trends, budget projections, and direct and indirect expense categories which are all reconciled to audited financial reports.
- Part D Expense and Reconciliation Models: Cirdan has developed automated models to evaluate Part D expenses and standard CMS and PBM reports to ensure that all coverage components, settlements and reconciliations are accurately assessed and captured for both bid purposes and ongoing financial reporting.
Dual-Eligible Population Analysis and Support
Cirdan performs experience analyses, capitation rate negotiation support, Medicare Advantage bid development, and provider performance analyses of FIDE-SNP plans. Our analysis and support include plans serving:
- Elderly and disabled populations
- Plans that include medical services, LTC and waiver services or
- All services on an integrated basis
Risk Adjustment Analyses
As consultants and actuaries, we understand the strengths, weaknesses and limitations of risk adjustment techniques. A plan’s “risk score” depends on the accuracy and completeness of the underlying data, as well as the actual illness burden of the population. . We help organizations use risk adjustment analyses to:
- Analyze business issues
- Develop process improvements in provider contracting arrangements
- Evaluate or enhance medical management initiatives
Reinsurance Analyses
Cirdan helps its clients assess the need for reinsurance protection against high-cost, infrequent and catastrophic events to reduce risk of adverse financial results. We can guide you through:
- The initial selection of reinsurer and coverage level
- Ongoing adjustments to the level of coverage to reflect changes in the underlying risk
- Evaluation of coverage provisions and reasonability of premium rates
- Design of programs in consideration of organizational needs
- Review of contract exclusions and limitations
ACO Strategic Planning and Development
Accountable Care Organizations (ACOs) are local health care organizations in which primary care physicians, specialists and hospitals work together to manage and coordinate care for a defined population. They work to provide high quality health care to patients efficiently, at a sustainable price and accept financial responsibility for patient care. Cirdan can help you:
- Assess whether an ACO is a viable option
- Evaluating the appropriate level of financial responsibility for the ACO
- Assess if you need reinsurance and other risk management programs
- Create a method for dividing payments between individual providers within the ACO
- Ensure the correct cost and utilization data is collected and analyzed
- With actuarial modeling and analysis in support of medical expense and administrative cost budgets
- Evaluate Value Based Contracts
Provider Reimbursement
Cirdan is experienced in reviewing, interpreting and modeling health care contracts and provider reimbursement arrangements. We can help you with:
- The development of basic contracting models
- Development and evaluation of risk-sharing arrangements
- Analyses of specific contract changes or alternative reimbursement models
- Reviewing contracts for ambiguities or “special provisions” that may create unnecessary risk
- Develop and evaluate Value-Based Contracts
Health Plan Design and Benefit Evaluation
Cirdan guides employers or brokers when they are deciding to make benefit or carrier changes. For example, we help assess premium rate feasibility and alternative financing arrangements, including self-insurance paired with stop-loss insurance. We can also evaluate:
- Alternative benefit designs
- Rate structures
- Contribution strategies
- Single vs. multi-plan impacts
- Risk adjustment issues