Axene Health Partners, LLC has many years of IBNR consulting experience and expertise. AHP offers monthly, quarterly  or annual estimates. This is in addition to our yearend statements of opinion/certification services.

AHP MARS involves a sequence of data manipulations (using SAS software), that summarizes detailed healthcare claims data into homogenous service categories, and then calculates various metrics such as utilization rates, PMPM costs, provider discounts, actuarial value, medical loss ratio, and risk score. The reporting interface is developed in Excel, and using Visual Basic for Application (VBA) programming, gives the user the ability to mass produce reports for various time periods, lines of business, market segments, healthcare providers (including PCP attribution), and clinical condition categories.

In addition to producing user-friendly reports, AHP MARS gives health plans (and hospital systems) the information needed to make strategic business decisions. Some of these decisions include (but are not limited to) the following:

• Initiatives to reduce emergency room visits, inpatient admissions, and inpatient length-of-stay
• Design and evaluation of provider contracts (including risk contracts, value-based payments, and PCP attribution)
• Design and evaluation of medical management programs
• Evaluation of risk appetite and decisions regarding market exposure and reinsurance

Contact us to learn more and get more information.

The AHP Actuarial Value Calculator (i.e., AHP AV Calculator) is a program used to develop estimated per member per month (i.e., PMPM) costs for a variety of different health care plans. It has the capability of pricing HMO, Point of Service, PPO, EPO, Open Access, and traditional indemnity products. Cost estimates can be projected using a variety of adjustments (i.e., trend, geographic region, medical management, demographics, etc.). AHP AV Calculator incorporates AHP Best Practice Norms™ to reflect the effect of an administrator’s medical management effectiveness. AHP AV Calculator can be used in concert with other AHP resources to develop complete estimates of costs (i.e., AHP Cost Model and AHP Fee Assessment Tool).

AHP AV Calculator uses both Microsoft Excel and Visual Basic for Applications (VBA) to provide a user friendly and efficient resource. The program operates within Excel using dialog boxes and VBA subroutines. For more information on this Model contact us today!

The Claims Projection System (i.e., CPS) is a user-friendly program for valuing incurred but not reported claim liabilities (i.e., IBNR). CPS bases its estimates on historical claims lag patterns as well as historical trends. CPS is a combination of both Microsoft Excel and Visual Basic for Applications (i.e., VBA). The program operates using dialog boxes and macros written in VBA.

In order to run CPS you are required to have:

• A license for AHP CPS™ from Axene Health Partners, LLC
• A computer with Microsoft Excel and VBA (VBA is accessed and available inside Excel)
• Paid Claims Data and Exposure / Membership information

If you are interested in finding out more information about AHP CPS™ or would like learn more about our licensing agreement contact us today.

The AHP Demographic Model™ (i.e., AHP DM™) is a program used to calculate age/sex loading factors for health plan premium rate development. The average age/sex loading factors are calculated by applying employee/contract distributions to proprietary demographic-specific health care cost factors developed and maintained by Axene Health Partners, LLC. AHP DM™ utilizes a unique Community Rating by Class (CRC) blending methodology to composite demographically adjusted information derived for each of three populations (PlanWide, Enrolled Group, and Total Group). This methodology smoothes the composite age/sex factor results to develop more useful information and minimize unnecessary adverse selection by groups with outlier demographic characteristics. AHP DM™ utilizes a combination of both Microsoft Excel and Visual Basic for Applications (VBA) to make AHP DM™ user-friendly and efficient to operate. The program is operated inside of Excel with dialog boxes and subroutines coming from VBA.

The AHP Fee Assessment Model™ (i.e. AHP FAM) is an Excel-based tool used to compare different fee levels or fee schedules to a selected version of Medicare fees (i.e., year). When you compare two sets of fees to Medicare you naturally have the information to compare the two sets of fees. AHP FAM bases its calculations on either a large set of CPT codes (i.e., almost all codes), or a small set of 343 codes distinct CPT codes that we believe to be representative of all codes. The comparison results are grouped into key service categories (i.e., inpatient visits, office visits, etc.). The detailed information is composited into service categories using one of four different distributions of fees. We provide “AHP standard” information for Commercial, Medicaid and Medicare beneficiaries and there is also the option to use a client specific distribution of fees (i.e., called “client” in the model). We recommend using client specific data as often as possible to be most representative of the underlying data.