Welcome to the website for the Wakely National Risk Adjustment Reporting Project (WNRAR). The objective of the project is to provide interim information for the risk adjustment program under the Affordable Care Act. This information is critical for health plan issuers for purposes of pricing health plans and estimating the ACA individual and small group risk adjustment transfer payments. Please review the tabs below for detailed information on this project.
Participation in the project will not require the transfer of any detailed data to Wakely or any other outside parties. Participating companies will only provide Wakely with summary level results after running the Wakely Risk Adjustment Reporting model code on their data. Wakely has implemented very strict controls and security to ensure that even the summary level results by health insurance company will not be shared. The only information that will be shared with other companies is aggregate results by state and market, across all health insurance companies. In fact, this aggregate information is the primary reason for companies to participate in this project. It is important to the success of this project that we receive notification of intent to participate from as many health plans as possible, as early as possible. It is important to note that intent to participate is not a binding agreement to participate, it only represents a health plan's intention at the time the notice is provided. Actual participation is contingent on results being submitted to Wakely and payment. To protect the confidentiality of health plan information and to ensure that the modeling is credible, Wakely has set a minimum participation requirement. We will require participation from at least 75% of the state and market and at least three health plans each representing at least 5% of the market. Given the difficulty to estimate ACA enrollment by issuer each year, we are valuing this qualitatively through inputs from participating issuers and historical membership reports. If either or both of the market minimums are not met and would likely not be met, we will contact all companies that had agreed to participate in that state / market and see if they would be willing to waive the minimum requirements and proceed with the simulation. How to Participate We have tried to make it easy to participate in the Wakely National Risk Adjustment Reporting Project. Just follow these steps:
The following notes are intended to provide a high level discussion of the proposed reports that will be returned to the participants of the project. A total of 8 versions of results will be provided for each of the 2020 runs. The result versions are described further below. Additional descriptions of the versions of results and the methodology used to create them are available in the associated WNRAR Report PDF which is provided to all participants each run. Unadjusted HHS (4 versions of results) Best Estimate of Morbidity (2 versions of results) Best Estimate of Risk Transfer (2 versions of results) The results will be presented with sufficient detail such that pricing actuaries will be able to consider and appropriately reflect the impact of allowable rate variation due to age. We will include issues specific to each state / market in our communication of the average results. Data provided to Wakely by health plans will not contain any financial expenditure information. Wakely will compile the results at a state and market level and provide those results compared to health plan results to each health plan that participated in a particular state / market. Information provided to each health plan will include the following: Wakely will review the results for each health plan for reasonability and only include health plan results in the state / market total if reasonable. We will contact health plans that submit unexpected results and work with them to identify and resolve any issues. If you are having difficulty accessing the pdf file, you can also link directly to the document by clicking here. Frequently asked questions are answered below. If you are having difficulty accessing the pdf file, you can also link directly to the document by clicking here.
The following resources may be helpful in understanding the ACA risk adjustment program. Please contact us if you think other resources should be included here (click to open). 1. Estimated benefit year[DG1] [CYC2] [DG3] risk adjustment payables and receivables. 2. Estimates of health plan specific risk scores by state and market for purposes of pricing and reserving products, as well as general strategic initiatives. 3. Preliminary estimates of Risk Adjustment Data Validation (RADV) program. 4. Estimates of High Cost Risk Pooling (HCRP) charge. 5. Data diagnostics to assess potential data issues early, so they can be corrected. 6. Detailed reports that show the key drivers behind risk scores. 7. Estimates on impact of your supplemental file at the issuer and market level. 8. A deeper understanding of the ACA risk adjustment program. 9. We expect HHS to provide return files to verify data uploads. We do not expect these files to include market averages, which would only be available on an interim basis through participation in the WNRAR project. 10. Further, we expect that HHS will not release any detail pertaining to: pre-ACA business risk scores; including 51-100 lives in small group in states where applicable; details by HCC and comparing issuer to market; completion estimates to risk scores. 11. Providing independent verification of market averages provided by HHS and derived from the enterprise data warehouse[DG4] rather than EDGE directly. [DG1]Do we want to remove the year so it does not have to be updated? This question applies in several places and several of the tabs. [CYC2]Yeah let’s not use year anymore [DG3]Okay. The only other place that year is listed out as 2020 is on the Technical Details page, but I think it makes more sense there given that is how it is in the description tab of the deliverables, so I think we can leave that and just try to remember to update it. [DG4]Anything else we want to add to this list? RATEE Reporting?Overview
Health plans participating in the project will receive the following benefits:
Technical Details
Wakely has issued several papers (see Resources tab) related to the risk adjustment and reinsurance provisions of the Affordable Care Act (ACA) . We believe it is critical for health plans to identify and correct data issues prior to submitting final EDGE data and to have estimated risk scores and risk transfers available early to price individual and small group products as well as estimate financial accruals.
Participation Guide
FAQ
Resources