Integrated Medicare Bid Simulator

Plan Inputs

Base Expected Claims PMPM: 400 ``` Utilization Trend (%): 5 Specialty Drug Trend (%): 5 Seasonality Amplitude (%): 5 Member Retention (%): 90 Target Profit Margin (%): 3 Credibility Weight (% Plan vs Regional): 80 Future Claim Variance (% for CI): 10 Include Catastrophic Specialty Shock

Clinical Metrics

A1C Level (%): 7 Blood Pressure (mmHg): 130 Cholesterol (mg/dL): 200 Lab Result Factor: 1

Historical Claims Weighting

Months 1-3 Weight: 1 Months 4-6 Weight: 1 Months 7-9 Weight: 1 Months 10-12 Weight: 1 ```

CMS & Risk Parameters

CMS Benchmark PMPM: 500 ``` Average RAF Score: 1.0

Risk-Adjusted Benchmark: $

Formula: Risk-Adjusted Benchmark = CMS Benchmark × RAF Score

Plan Bid PMPM: $

Formula: Bid = Credibility-Adjusted Historical Claims × Clinical & Pharmacy Factor × Retention × (1 + Profit Margin) + Catastrophic Shock

Rebate: $

Formula: Rebate = max(0, Risk-Adjusted Benchmark − Bid)

Expected PMPM Range (Confidence Interval): $ - $

Formula: CI = Bid ± z × √(Variance × Bid² × (1−Credibility))

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Integrated Medicare Advantage Bid Simulator

Basic Bid + Clinical & Pharmacy + Historical Claims Weighting

Plan Inputs

Clinical Metrics

Historical Claims Weighting

CMS & Risk Parameters