Press Release (ePRNews.com) - TAMPA, Fla. - Jun 04, 2019 - Wakely Consulting Group, a company of consulting actuaries and health care specialists who provide actuarial expertise in the health care industry, released early estimates of the 2017 Affordable Care Act (ACA) risk adjustment data validation (RADV) results in January, which have proven to be right in line with Centers for Medicare & Medicaid Services (CMS) results released at the end of May. CMS released 2017 ACA Risk Adjustment Data Validation (RADV) results on May 31, 2019, including national benchmarks of average mean failure rates and confidence intervals. These values are used to determine issuer and market error rates under the RADV program, which affect issuer’s 2018 risk adjustment transfers (to be released by CMS in June 2019). Participants in Wakely’s National Risk Adjustment Reporting (WNRAR) project received preliminary estimates of the RADV results as early as Jan. 29, 2019, allowing them to plan for the financial impact of the program. The 2018 risk adjustment transfer estimates from the WNRAR project were used in tandem with the RADV results. In addition, participants received estimates of adjustments to risk adjustment risk transfers under the 2016 pilot program in October 2018, allowing them to understand its potential impact and to address key operational programs in advance of actual implementation.
Wakely’s estimates of the national benchmarks turned out to be almost spot on, with differences of only 0 to 0.6 percentage points. Wakely’s modeling suggested some issuers may owe or receive as much as nine percent of their annual premiums under the ACA’s RADV program, consistent with CMS’ RADV results.
Chia Yi Chin, Wakely’s lead on the project, stated, “The project is a collaborative effort between the participating issuers and the Wakely team. We are absolutely thrilled with the results and are looking forward to working with the plans to try to pin down future national and state-specific values, which could change substantially.”
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Chia Yi Chin, ASA, MAAA
Wakely Consulting Group LLC