Cambridge’s team consists of actuaries, clinicians, economists, doctorates in public health, revenue cycle enhancement specialists and other benefit experts. We utilize sophisticated proprietary data management tools to perform multi-disciplinary and integrated population based analysis.
We approach our large, complex clients as if they are the insurer of their covered population. We assist by asking detailed and non-traditional questions designed to assess, abate, and manage risk. Cambridge goes to great effort to identify the underlying causalities of risk, costs, and liabilities with a particular focus on the “at risk” and “of need” segments of the clients’ covered population who drive a disproportionate percentage of costs.
We assess, quantify, and create integrated solutions regarding risks and costs that apply across multiple plan types. An example of this work is recognizing the cost and issues surrounding high cost medical claimants who are also subject to EAP, FMLA, and disability benefits.
Our technical services include:
- Data collection and analysis of risks, costs, and liabilities utilizing a unique hierarchy of varying data sets;
- Conduct internal actuarial and clinical analysis of claims experience, premiums paid, claims reserves, and fund requirements as requested;
- Establish appropriate accrual rates and reserves for all self-insured plans as well as determine appropriateness of rates and reserves put forward by carriers for insured arrangements;
- Maintain records of financial and claims experience, condition, and progress of the client’s plans. Provide the client with quarterly reports;
- Development of customized reporting packages specific to individual client needs;
- Analyze and integrate all available clinical data from the sponsored programs to establish proper risk and cost baselines;
- Project the possible effects of various health risk management tools;
- Assess the client’s tolerance for risk, develop corresponding risk management strategies in order to lower plan costs and improve predictability;
- Analyze the value of various network and clinical management alternatives around cost, value, appropriateness, and results;
- Create needed ROI models which quantify and qualify the value of such factors as satisfaction, absenteeism, turnover, and morbidity;
- Provide needed Medicare Part D attestation and accompanying subsidy calculations;
- Perform needed Discrimination Testing for IRC Sections 105, 125 and 129;
- Calculate and provide FAS 106 and 112 liability studies;
- Prepare alternate funding analysis including the possible use and implementation of a Captive entity, PDPs, and other available solutions.