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Insurer Analytics



HCC Scores and Risk Adjustment Factor Analysis


Copharix Hierarchical Condition Category (HCC) simulation models and decision theoretic optimization algorithms are being provided as a service primarily to CO-OP Insurers.  CO-OP Insurers were created under provisions of the Affordable Care Act.  Our business model for these services is driven by the requirement that CO-OP Insurers must provide annual assessments of claims and risks to CMS.  Because CO-OP Insurers are new in the market, they typically do not have the internal capabilities to implement the required reporting unless they get outside assistance.  Copharix will provide consulting services which are based on providing analytic tools and methodologies that: (A) characterize the claims risks of CO-OP Insurers; and (B) provide insights to decision makers to enhance their ability to evaluate business risk tradeoffs and the costs associated with mitigation of those risks. 


The analysis of interactions that affect CO-OP Insurer claims risks, HCC Scores and Risk Adjustment factors will be modeled using a variety of analytic methodologies and algorithms.  Copharix’s integrated approach for the development and implementation of comprehensive methodologies for the optimization of for example: (A) incentive payments to reward Care Team performance; (B) incentive rewards for patients to influence desirable behaviors; and  (C) health insurance policy premium strategies designed to achieve the financial and claims objectives of insurer based on their objectives.   Copharix has partnered with a leading actuarial firm to develop  mathematical algorithms, actuarial analytics and optimization algorithms that constitute an innovative approach for the dynamic management of patients’ healthcare risks and insurer ‘s claims and financial risks.  This approach focuses on a more proactive methodology for managing patients’ healthcare outcomes risk and managing insurer’s claims and financial risks.  

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