Rating Engine
Sophisticated actuarial models built on comprehensive claims data — specialty sub-capitation, episode-based contracts, case rates, and total cost of care analytics.
Spreadsheets weren’t built for this.
in annual healthcare spend flows through negotiated rates
Healthcare rating is still dominated by manual processes — actuaries pulling claims extracts, building one-off models in Excel, and producing rate recommendations that are stale before they’re delivered. The problem isn’t talent. It’s tooling.
Sub-capitation rates, episode-based contract terms, and case rate structures all require claims-level granularity that flat-file analysis can’t efficiently deliver. Ariv’s Rating Engine brings structure to the process. Claims-driven models for specialty sub-capitation, episode-based contracts, case rates, and total cost of care — with the transparency and auditability that actuaries and underwriters demand.
What you can do with it.
Specialty Sub-Capitation Rating
Develop and validate sub-capitation rates for specialist services using claims-level cost and utilization data. Model risk corridors, outlier provisions, and trend factors with full transparency.
Episode-Based Contract Modeling
Define clinical episodes, assign costs from claims, and model episode-based payment structures. Evaluate gainsharing thresholds and provider performance tiers.
Case Rate Development
Build defensible case rates grounded in actual claims experience. Analyze cost distributions by service type, acuity, and geography to set rates that balance adequacy with competitiveness.
Total Cost of Care Analytics
Comprehensive per-member cost modeling across the full care continuum. Decompose total cost by service category, provider, and population segment to identify cost drivers and savings opportunities.
Claims-Driven Models
Every rate recommendation traces back to verified claims data. No proprietary black-box scores — full auditability from input to output.
Configurable Rate Structures
Flexible modeling framework that adapts to your contract structures — per-episode, per-member, per-case, or blended.
Trend & Projection Engine
Forward-looking rate projections incorporating utilization trends, unit cost inflation, and population health shifts.
Collaborative Workbench
Shared workspace for actuaries and underwriters to develop, review, and approve rate recommendations with version control and audit trails.
Stay Tuned.
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