Cirdan’s client was a provider of specialty medical services, and they provided services for health plans on a delegated basis with financial risk. The client needed actuarial talent that understood provider contracts involving captiation and case rate contracts and with expertise in building pricing models to help them in their contract negotiation process.
- Cirdan assisted the client by analyzing their historic claim experience
- Cirdan built a customized pricing tool to support rate development for future opportunities. The tool:
- Included pricing flexibility for a per case or per member per month rate structure
- Allowed the end user the ability to vary administrative expense loads and provider fee levels to accommodate a quote for a new group
Our client had a model that allowed for easy evaluation of new and renewing contracts in a consistent manner, with flexibility to look at multiple contracting approaches.