Increasingly, the payer industry is a data-driven enterprise. And this means you need a partner like SCIOinspire that delivers a wide variety of integrated actuarial models and support for underwriting, pricing, trend analysis and population studies.
SCIOinspire also has its eye on the future of healthcare, during this time of turbulence and transition. Members of our executive team are influencing public policy through health reform in Massachusetts and are uniquely qualified to assist clients as they respond to new directives being discussed in Washington.
SCIOinspire offers extensive experience in the application of actuarial techniques within managed care and clinical environments, with specific expertise in areas like wellness and value-based purchasing to assist you in quantifying and pricing the effect of various programs. Our staff of highly trained actuaries applies years of experience to ongoing client needs and special projects. Available on an as-needed basis, SCIOinspire resources eliminate the need for clients to retain actuaries on staff.
All told, SCIOinspire actuarial and underwriting support helps you identify provider cost trends and other qualitative indicators that are increasingly important to success. At the same time, we assist in helping you address the difficulties of collecting risk profiles and demographic details for underwritten groups.
In todays difficult climate, healthcare payers struggle with:
- Need for reliable data and rates for pricing services
- Difficulty in collecting risk profiles and demographic details of underwritten groups
- Identification of provider cost and utilization trends
- Obtaining rate approval by a credentialed actuary
- Management of complex databases
- Development of financial projections and pro-forma analysis
- Calculations for reserve, capital adequacy and surplus development
- Analysis of cost and utilization trends
- Clinical modeling, including understanding clinical drivers of utilization
- Feasibility and evaluation of care management programs
SCIOinspire delivers:
- Need for reliable data and rates for pricing services
- Difficulty in collecting risk profiles and demographic details of underwritten groups
- Identification of provider cost and utilization trends
- Obtaining rate approval by a credentialed actuary
- Management of complex databases
Using claims and enrollment data, SCIOinspire has developed a variety of integrated actuarial models to support our clients' programs and priorities. Areas of expertise include:
- Data cleansing and validation
- Data mining and predictive modeling using custom and industry models
- Cost and utilization models
- Trend studies
- Care/disease management program studies (both feasibility and evaluation)
- Clinical modeling including understanding clinical drivers of utilization
- Predictive modeling applications such as underwriting, forecasting, pricing, population studies, trend analysis and risk-burden development
- Contract evaluation, reimbursement, pay-for-performance and outlier payments
- Rate filings
- Reserve capital adequacy and surplus development
- Small and midsize group underwriting
- Actuarial Services Portfolio
