Tag Archives: Milliman Advanced Risk Adjusters

Milliman Advanced Risk Adjustment™ (MARA™) software tops the competition in risk scoring study

laurent-dianeMilliman’s popular Milliman Advanced Risk Adjusters™ (MARA™) software topped the competition in the latest study by the Society of Actuaries (SOA), “Accuracy of Claims-Based Risk Scoring Models.” Milliman achieved the highest overall performance among concurrent models, beating out 11 other vendors. MARA’s prospective models scored similarly well, ranking at or near the top in all four primary metrics measured.

MARA’s performance is proof of what we’ve known all along—the Milliman Advanced Risk Adjusters software is a leader in claims-based risk scoring models, and one of the most accurate tools on the market.

Since the passage of the Patient Protection and Affordable Care Act (ACA), risk scoring models play a central role in predicting or explaining healthcare expenditures. As in each of the previous SOA studies, coefficient of determination, or R2, was used as one measure of predictive accuracy and indicates how well data fit a statistical model. With an R2 of 55.4%, MARA’s concurrent diagnosis and pharmacy model (CxAdjuster) leads the competition with the highest observed R2 for uncensored costs. For costs censored at $250,000, the same model achieved the highest R2 to occur in the study, at 66.7%.

We were especially pleased that in an exploration of ensemble methods of modeling, more weight was put on the MARA model than any other. To me that indicates that giving MARA the most credence resulted in the best performing composite prediction.

MARA models are valued by clients because they produce separate risk scores for major categories of service, including inpatient, outpatient, emergency room, physician, pharmacy, and other medical care. Beyond risk scores, all MARA models provide a probability of inpatient admission and emergency room visits, plus the contribution of clinical risk drivers for more than 1,000 medical conditions.

The study, released Monday October 25, is published by the Society of Actuaries.

How can risk adjusters improve the accuracy of value-based payment?

Providers should understand the health insurance risk they assume through value-based payment contracts, and how this might impact their reimbursements. Risk adjustment tools like the Milliman Advanced Risk Adjusters™ (MARA™) suite identify and isolate morbidity risk factors that are beyond a provider’s control. This may result in payments that more accurately reflect a patient population’s controllable risk. In this article, Milliman’s Colleen Norris and Stoddard Davenport demonstrate how risk adjustment can minimize the financial exposure associated with the morbidity risk that providers cannot influence.

Federal health exchange risk adjustment model now available in Milliman Advanced Risk Technologies’ MARA software

Milliman has announced the expansion of its Milliman Advanced Risk Adjusters (MARA) software to include greater flexibility for calculating risk scores in and outside of health exchanges. The latest release includes the federal risk adjustment model developed by the U.S. Department of Health and Human Services (HHS) for use in the individual and small group marketplaces starting in 2014. The complex HHS-HCC model set, which employs the hierarchical condition category (HCC) grouping logic, requires specific diagnosis and demographic handling to calculate risk scores.

“Our latest product release is a testament to our commitment to provide healthcare organizations with on-demand risk scoring solutions in support of their reform initiatives,” said Diane Laurent, MARA’s managing director.

The HHS-HCC risk adjustment model is provided in a platform-independent software package that is easy to install in any environment. Clients who wish to tightly integrate the processing engine receive automated processing interface support. Milliman’s MARA product is proven technology with analytical support available from Milliman’s consulting actuaries and other industry experts.

“The MARA tools give the industry on-demand processing of metallic-level and cost-sharing reduction (CSR) risk scores, with completely transparent scoring. Adding the HHS-HCC risk adjustment model means plans and others have another powerful tool for understanding and managing risk in their own technical environments,” added Hans Leida, Milliman principal and consulting actuary.

In addition to the HHS-HCC risk adjustment model, MARA includes a library of more comprehensive, higher-performing risk adjustment tools that are widely deployed in solutions offered by leading healthcare technology providers, including business intelligence, care workflow solutions, and electronic medical records (EMR) vendors. MARA adds insight for population health activities in accountable care organizations (ACOs), primary care medical home programs, and other health-based budgeting, pricing, and risk-based performance measurement programs.

For more information, go to www.millimanriskadjustment.com.

Milliman to showcase Healthcare Intelligence products at America’s Health Insurance Plans (AHIP) 2014 Institute Conference

Milliman announced today that it will showcase its growing line of Healthcare Intelligence products and solutions at AHIP’s Institute 2014, June 11-13, in Seattle. Milliman is exhibiting as an AHIP major sponsor and conference attendees will be able to stop by booth 810 to learn more about or schedule private presentations for all Milliman Healthcare Intelligence products.

Kent Sacia, Milliman Principal, is a featured panelist at AHIP’s Data Analytics Forum, part of the extended Institute Plus conference, and will discuss infrastructure, technology challenges, and the future of big data.

Milliman Healthcare Intelligence products such as MedInsight®, IntelliScript®, Health Cost Guidelines™, and Milliman Advanced Risk Technologies™ will be represented, along with newer products including HealthcareEDU and MyRxConsultant.

Many Milliman Healthcare Intelligence practices will be on site to showcase their latest products and releases:

• The MedInsight team will be available to discuss the upcoming launch of its new MedInsight Platform this fall, built on Microsoft’s powerful Analytic Services Platform. This significant update will improve client data refresh time by as much as 75% and data retrieval time by as much as 90%.
IntelliScript will be featuring AlertRx, a tool for payors to optimize their risk adjustment revenue.
Health Cost Guidelines (HCG) will be on site to discuss the data and rating tools for modeling healthcare utilization and to showcase the HCG Grouper software that sorts medical and pharmacy claims data into hospital, surgical, medical, and other benefit service categories.
• The Advanced Risk Technologies team will be highlighting their latest release of Milliman Advanced Risk Adjusters™ (MARA™), Milliman’s powerful risk adjustment and predictive modeling software.
MyRxConsultant will be showcasing their product of the same name, a pharmacy analytics tool that processes claim data to generate pharmacy benefit costs and experience reports on demand.
HealthcareEDU will be demonstrating their new e-learning courses, specializing in educating your workforce on the healthcare market and its evolution.

To learn more about Milliman Healthcare Intelligence, visit booth 810 at AHIP’s Institute, or visit us at www.milliman.com.