Healthcare risk modeling

Milliman Advanced Risk Adjusters

At the heart of population health analytics

Milliman Advanced Risk Adjusters

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The challenge

Understanding health risk requires in-depth insight into complex medical and social factors

When your challenges include financial and care decisions, Milliman Advanced Risk Adjusters® (MARA) helps you face those challenges with confidence through better understanding of the needs and risks of your population.

The solution

Get ahead of risk with MARA, an industry-leading solution for population health analytics

MARA population health models and tools offer person-centric, clinically meaningful risk profiles. Discover risk by health service categories to:

Analyze acute, chronic, complex, and social drivers of clinical risk
Segment members by expected cost increase or decrease
Identify risk of emergency department visit or hospital admission
Evaluate social and community-specific health risk factors

Deeper insight: Managing behavioral health for Medicaid populations

“We have risk scoring that we have access to, but it doesn’t give us the depth of that score that MARA gives us.”

Managing behavioral health requires a “whole person” perspective. Having a better understanding of how behavioral health conditions can contribute to clinical outcomes allows organizations to staff by priority, refer appropriately, and measure the value of clinical interventions.

Make financial decisions with confidence

Table from Analytic Guide demonstrating risk and clinical risk drivers by employers

For health plans, payers, and third-party administrators (TPAs)

Assess and compare risk among employers, providers, accountable care organizations (ACOs), and lines of business, while gaining insight to support budgeting, pricing, underwriting, risk adjustment, payment, and program measurement.

Table showing a provider efficiency example

For providers and ACOs

Gain predictive insight for risk-sharing programs, value-based contracts, and performance measurement systems. Monitor concurrent risk over time to track changes in patient risk profiles, segment patients whose costs will increase and stay ahead during the performance period.

Rising Risk

MARA’s powerful Rising Risk models

MARA Rising Risk models differentiate, classify, and allow users to assemble cohorts of members by whether their cost will stay the same, decrease, or rise. MARA results offer greater precision for classifying populations, identifying risk drivers and enabling better decisions for care programs, staffing needs to achieve results, and measuring success.

BENEFITS

MARA Benefits

Analyze results using tools of your choice

Visualize MARA results within your current reporting platform, or load MARA output into pre-designed MARA templates using Microsoft Power BI.

Predict Medicare Advantage risk more effectively than using hierarchical condition categories (HCCs) alone

Gain deeper insight with more comprehensive clinical profiles, highlighted chronic and complex conditions, and granular risk predictions across eight service categories. Identify manageable events based on inpatient and emergency department risk scores. Improve selection for care planning and care transformation using MARA Rising Risk predictions.

Improve stratification with complexity indicators

Prioritize members who are both high cost and clinically complex. In a Medicare population study, members identified with just one Complexity Indicator were expected to be twice as costly as members with one chronic condition and three times more expensive than members with a single medical condition.

Get rapid results

Accelerate decision making, leverage MARA application programming interfaces (APIs) for the cloud to speed up processing.

MARA models recognize social factors

Providers are capturing data on the social needs of their patients using ICD-10-CM Z codes. When coded in medical encounters, MARA adds these important social needs to member profiles. MARA’s Clinical Classification System includes 10 social categories identifying non-medical factors that may influence health status. To learn more about the importance of social factor coding visit: IMPROVING THE COLLECTION OF Social Determinants of Health (SDOH) Data with ICD-10-CM Z Codes (cms.gov).

Complete and annualize risk scores

When you need to estimate the final risk score for individuals based on a partial year of data, MARA’s 4CAst models complete and annualize risk scores.

FEATURES

MARA features

Industry-leading health risk models enhance predictive analytics

Benefit from the highest overall performance among 11 other claims-based predictive risk models.

Accuracy of Claims-Based Risk Scoring Models (soa.org)

Responsive client services

Engage the team behind MARA directly to help with implementation, technical support, and user training so you can get the most value from your investment. Add Milliman consulting expertise for critical financial applications, including value-based payment, underwriting workflow, care analytics, and predictive analytics.

Flexible licensing

License only the models you need from the extensive MARA Library. Select models based on your organization’s business applications, population types, and available data.

Simple deployment and management

Keep data local with a platform-independent solution that runs on Windows, Linux, and Unix desktop environments, or run in the cloud for maximum performance. You can use MARA through a graphical user interface, batch mode, or APIs for JavaScript, .NET, or MARA Spark API + Databricks.

Consistently updated

Stay current with rapid changes in healthcare coding and treatment thanks to easy code updates for new drugs and diagnosis codes.

Load and process historical data using MARA’s Rolling Risk feature

Select this time-saving feature when processing two or more years of historical data. Observe risk changes over time with this efficient feature.

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Contact a MARA™ expert

We’re passionate about partnering with people to solve complex problems. Let’s chat about what’s going on with your business, and how we can help.