The Optumas team calculates the impact of programmatic changes on budgets and premiums. These programmatic changes can impact
- The population (i.e., who will enroll and show up for services due to the change?),
- The benefits (i.e., what types of benefits will enrollees receive?), and
- The reimbursement (i.e., mandating use of certain fee schedule as the floor).
We work closely with our clients to understand the programmatic change in order to determine all of the impacts on all of the various programs since there are typically ripple effects of the change. For example, increasing pharmacy benefit coverage for a particular program will typically bring in additional enrollees who are riskier than those originally enrolled.