How can we help?

Capitation Rate Development and Review

  • Review and development of actuarially sound capitation rates for Medicaid Managed Care and Managed Long Term Care programs
  • Development of capitation rate for subcapitated providers
  • Risk adjustment model development and application
  • Provider incentive arrangements and evaluation
  • Provider efficiency assessment and savings quantification

Forecasting and Reporting

  • Development of revenue and expense trend estimates for budgeting and reporting
  • Coordination of analytics and implications across all health plan departments
  • Support for quarterly and annual financial statements and reconciliations internally and with external auditors

IBNP and Reserve Estimation

  • Plan-specific modeling to balance goals of timeliness, thoroughness, and accuracy of estimates
  • Monthly, quarterly, and annual development of appropriate reserves
  • Retrospective reserve adequacy to refine modeling and inform Provision for Adverse Deviation (PAD) estimates
  • Quantification of emerging service utilization and cost trends
  • Identification of changes to payment patterns and impacts to reserves and health plan operations

Data Warehousing and Analytics

  • Aggregation of complex eligibility and payment data
  • Manipulation of data to identify actionable information
  • Data reasonableness and integrity reviews
  • Encounter quality and under-reporting assessments
  • Encounter data pricing

About EHC

Edrington Health Consulting (EHC) was formed in 2014 and has provided consulting services to health plans, State agencies, provider groups, advocacy groups, and other stakeholders in the health care marketplace.

We work with our health plan clients to maximize their understanding of complex reimbursement mechanisms, design and implement provider contracting arrangements, improve internal analytic and reporting capabilities, and generally mitigate risks present in the ever-changing health insurance market.

We additionally support State agencies in the administration of public insurance programs with a focus on the review and development of actuarially sound capitation rates, risk-assessment methodologies, alternate payment mechanisms, and general program design.

This experience has created a unique perspective that allows us to most effectively strategize, develop, and implement cohesive solutions that consider the goals of our clients as well as their industry partners.

Get In Touch

We look forward to hearing from you.

Call us today at: 602-899-7800

Email: contact@edringtonhc.com

9420 E Doubletree Ranch Rd #110
Scottsdale, AZ 85258