MLTC Risk Model Workgroup Meets

Last week, the Department of Health (DOH) along with Deloitte, the State’s contracted actuary, held the second Managed Long Term Care (MLTC) Risk Model workgroup meeting. The purpose of the workgroup is to help Deloitte and DOH update the model that will be the basis for calculating risk scores for April 2019 rates. This process includes selecting Uniform Assessment System (UAS) variables that are predictive of service utilization then developing appropriate cost weights for each selected variable. Once finalized, the model will be applied to the latest UAS data to calculate plan-specific rate adjustments to reflect plan member acuity.

At this stage of risk model development, Deloitte has tested a large number of variables (i.e., UAS responses) for their predictive value and has a draft set that is performing better than the previous model. While Deloitte did take plan input into consideration in their modeling work, some workgroup participants provided additional recommendations and requested further statistical analyses. Although there had been discussion in the previous workgroup meeting of the importance of considering the interplay of multiple variables, Deloitte has not yet tested interaction predictors other than those that were included in the prior model.

One goal of the update project was to explore whether the risk adjustment model could make the high cost/high need pool no longer necessary. Deloitte indicated that they were still testing how well the model addressed high cost/high need populations and acknowledged that there would always be cases that risk adjustment would not capture.

Although DOH and Deloitte expressed their intention to have the model finalized before the April plan rate meeting, they conceded that if there were a significant number of comments or requests for additional statistical testing, that date would be impossible to meet. Workgroup members agreed that it was more important to ensure the model was as strong as possible, even if it did delay issuance of risk scores.

LeadingAge NY Contact: Darius Kirstein, dkirstein@leadingageny.org, 518-867-8841