Wakely Risk Insight for Medicare Advantage
Wakely Risk Insight: Analyzing profitability, maximizing results.
Understanding profitability in the Medicare Advantage (MA) market enables plans to thrive and enhance their offerings to better serve members. Our proprietary Wakely Risk Insight (WRI) tools highlight key profit drivers tied to actionable strategies, helping plans improve their likelihood of operating profitably based on the members they attract.
The WRI framework analyzes over 100 member-level markers using our proprietary algorithm to identify profit and loss drivers. It is highly customizable to meet each client’s unique needs.
How WRI can help your organization.
Using the WRI framework, Wakely is able to provide valuable reports and tools for our clients.
Request a consultation to learn more about Wakely Risk Insight for Medicare Advantage.
Wakely Medicare National Report
This free annual Medicare Advantage plan profitability study provides valuable insights. Participants who share de-identified data receive two major deliverables in return:
- A report describing key patterns and drivers of profitability across the participant benchmark dataset
- A Microsoft Excel Suite that contains:
- Key drivers of profitability specific to each participant alongside a comparison to the aggregate participant benchmark data
- Organization-specific HCC prevalence and recapture rates, alongside benchmark results
Wakely has been conducting the Medicare National Report for the past five years, expanding the number of plan participants and member months significantly since its inception.
Here’s a summary of the invaluable exhibits our participants receive:
- Top drivers of profitability – Aggregate and PMPM
- Experience year financials
- Cost model
- RX utilization and cost data
- Summary of top 100 NDCs in national data
- Medical & RX continuance tables
- Cohort analysis – by risk model
- HCC prevalence report
The Wakely Medicare Advantage De-identified Dataset: The byproduct of the Medicare National Report is the Wakely Medicare Advantage De-identified Dataset, a large database of MA claims, revenue, and profitability. From this, we can perform numerous custom analyses for your organization.
Wakely Risk Insight Medicare Advantage Pro (WRIMA Pro)
WRIMA Pro is an enhanced version of the Medicare National Report which examines profitability on an adjusted historic basis, helping plans prepare for changes forthcoming to the Medicare Advantage market. WRIMA Pro also allows for significant customization to the member markers examined and resulting deliverable views and exhibits.
WRIMA Pro helps you examine the “new normal.”
WRIMA Pro analyzes not only historic profitability drivers, but also provides an adjusted historic look at profitability which incorporates the impact of recent Medicare Advantage changes. Specifically, the following:
- Part D Risk Model Change: WRIMA Pro applies the new post-IRA 2026 proposed Part D risk score model
- Part C Risk Model Change: WRIMA Pro gives 100% weight to the new v28 Part C Risk Score model.
- Part D Benefit Adjudication: WRIMA Pro re-adjudiciates Part D claims under the post-IRA 2026 Defined Standard benefit. This includes adjustments to reflect the Maximum Fair Price for drugs under the 2026 Medicare Drug Price Negotiation.
Need additional analyses? Just let us know.
We collaborate with our clients to create custom exhibits that can help answer questions, solve problems, support decision making and explore new opportunities unique to their organization.
Examples of custom reports:
- Total Cost of Care and Benchmarking by Cohort
- Profitability analysis for high/medium/low utilizers of various benefits
- Further HCC Prevalence, Recapture, and Association Benchmark Reporting
- and more
Please reach out to to discuss your reporting request, pricing, and timing.
