Products
Axene Health Partners, LLC designs and produces many Actuarial & Healthcare related programs that are for sale. Custom programs can be made upon request. Some examples of programs currently offered are below.
The AHP Cost Model
The AHP Cost Model (i.e., AHP CM) 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. AHP CM incorporates a selection bias model to reflect individual selection patterns varying both demographic and health status mix. Cost estimates can be projected using a variety of adjustments (i.e., trend, geographic region, medical management, etc.). AHP CM incorporates AHP Best Practice NormsTM to reflect the effect of an administrator's medical management effectiveness. AHP CM is used in concert with other AHP resources to develop complete estimates of costs (i.e., AHP DM and AHP Fee Survey).
AHP CM AHP Cost Model 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 email info@axenehp.com
AHP CPSTM
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
A computer with Microsoft Excel and VBA (VBA is accessed and available inside Excel)
Paid Claims Data and Exposure / Membership information
To make AHP CPSTM
easy to use and navigate through it has been designed around a menu
called the AHP Menu. The AHP Menu is where the entire program
is controlled from. It takes you step by step from entering
data, all the way to saving and printing.
The initial data is arranged using claim triangles, incurred months are on the vertical axis and the paid months on the horizontal. This data is later manipulated in order to more easily view the outcomes.
AHP CPS
TM calculates completion ratios in 8 different ways and allows the user to decide what way is best. If the user is not satisfied with the factor construction they are able to weight up to eight different factors into a combined factor.The key to a successful IBNR system is the use of manual adjustments. In AHP CPS
TM manual adjustments are made in many different ways and are easily verified. The Claims Liability Table is probably the most important worksheet in the entire program. This is where you review your first run answers and potentially change or adjust the results to get more reasonable answers. No claims liability methodology works 100% of the time and adjustments are expected based upon professional judgment. The CPS system is built around the concept of easily adjusting results to provide the best possible answers. Do not accept your first result. Check it carefully or your answers may be incorrect.AHP CPS
TM allows changes to be easily done to the Completion Factors, Estimated Incurred Claims, Monthly PMPM’s, and the Trend. The first three are as simple as typing in new answers will the trend is done with the use of the trend calculator. The Trend Calculator has four sections that allow the user change either one, three, six, or twelve month rolling average trend factors.The eight Monitoring Reports are used to further analyze the data. The first five are the PMPM trend reports. These trend reports look at trends in the different categories. The next three reports are the analysis reports. The analysis reports have three main objectives: to calculate multipliers, create a restatement of prior reserve report, and finally make a tables and graphs that show the seasonality.
If you are interested in finding out more information about AHP CPSTM or would like learn more about our licensing agreement email info@axenehp.com
AHP DMTM
The AHP Demographic ModelTM (i.e., AHP DMTM) 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 DMTM 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 DMTM utilizes a combination of both Microsoft Excel and Visual Basic for Applications (VBA) to make AHP DMTM user-friendly and efficient to operate. The program is operated inside of Excel with dialog boxes and subroutines coming from VBA. In order to run AHP DMTM you are required to have:
AHP Fee Survey
The AHP Fee Survey (i.e., AHP FS) is a program used to assess provider payment levels and compare them to other fee levels and/or current Medicare payment levels. A sample of about 300 procedure codes are used to complete the assessment. Analysis utilizes current Medicare RBRVS unit values to derive effective conversion factors by procedure code. Conversion factors are composited to describe provider payment levels in terms of a single composite conversion factor.
AHP FS can be used by itself or in concert with AHP Cost Model to reflect a specific provider fee level.