Actuarial and Risk Management Services for Value-based Payment Arrangements

The team at Wakely includes diverse professionals with a comprehensive understanding of the entire spectrum of healthcare, including substantive experience working with providers as they transition from traditional pay-for-service models to complex pay-for-value models.

Wakely’s staff has extensive experience and expertise in working with healthcare data in support of provider organization initiatives, from developing and maintaining reporting programs and structures, to marshaling sophisticated analytics in support of key strategic decision-making.

Services Provided

Strategy and payer engagement

Wakely’s strategy and payer engagement services leverage our robust payer and CMS / CMMI model knowledge and proprietary data sets.

  • Program, product, or service area feasibility analyses.
  • Value-based contract or alternative payment model review, assessment and negotiation support.
  • Value-based contract or alternative payment model projections and financial modeling.
  • Provider network change impact analyses and tools.
  • Payer-provider trusted data warehouse intermediary.
  • Payer-provider joint economics models.

Performance evaluation, analysis and improvement

Once hospitals and health systems enter value-based arrangements or other alternative payment models, Wakely can serve as a trusted advisor to help providers understand how they are performing and outline areas of opportunity for improvement.

  • Value-based contract or alternative payment model reconciliation support and settlement analysis.
  • Benchmarking cost, utilization, and clinical outcomes, leveraging Wakely data sets.
  • Total cost of care, utilization, unit cost analysis, and population health insights.
  • Risk score opportunity and accuracy analyses and tools.
  • Provider and patient level scorecards and profilers.

Administrative and operational services for organizations within value-based / risk arrangements

Wakely can support a host of other key administrative and operational functions as an organization progresses throughout its value and risk-taking journey.

  • Downstream shared savings and loss strategy and analysis.
  • CCLF and claims data processing.
  • Ad hoc analyses and population deep dives.
  • IBNR and reserving.
  • Risk score accrual estimates.
  • Year-end statements.
MHA Endorsed Business Partner

Contact Information

Kelsey Stevens, FSA, MAAA, MBA
Principal and Senior Consulting Actuary
(727) 776-2709
Email: Kelsey.stevens@wakely.com