NEW AEP Enrollment Predictions as a Service by HealthWorksAI

Apple Release - Jan 2023

Jan 6th is Apple Tree Day in the United States, and it is celebrated for its fruit and importance in our lives. Similarly, our “Apple Release” is our first 2023 triannual release report that showcases all the hard work that went into each of our product lines and its importance for payors.

This release provides clients with updated AEP enrollment data and access to enhanced xAI features, which can be used by Payors to plan and optimize for future enrollments.


The benefit simulator is getting a facelift and moving to the latest technology stack for a better user experience. You can use the simulator to understand the impact of the changes in significant copay/ coinsurance/ coverages on enrollment. And then, you can take a call on final values basis your appetite.

The following are a few major changes in functionality:

  • Create duplicate scenarios
  • Compare multiple scenarios seamlessly on the portal itself
  • Filter plan selections by organization
  • Collapsible benefits – You need not scroll through all the benefits to get to the lower section
  • Intuitive Sub-benefit selections – Move from the current PBP-based binary input (0 and 1 format) to select your sub-benefit by just checking/clicking on it

Once the significant benefits are identified, the next question is, at what costs should you offer these significant benefits? Offering every benefit at $0 is not feasible. Benchmarks attack that question directly:

  • Benchmarks provide inputs on the optimal/ideal benefit design
  • Identify how much you should offer each significant benefit at
  • Guide you to design your plan accordingly for each market

Currently, if you need to understand a particular organization’s details and performance, you might need to go to multiple dashboards. This will be a one-stop solution to understand everything about an organization – from the benefits it focuses on to their growth and current status.

Add/remove physician groups, health systems, hospitals, etc, to assess the impact it has on

  • provider network score of your plan
  • plan enrollment
  • Additional data to show you which physician groups, and which health systems your competitor networks are contracted with.
  • NPI score of each provider to help you see which providers are unique to competitor networks are the most valuable.
  • Enhanced, feature-rich, and performance-optimized version of Data Cube.
  • Slice and dice the data to gain insights in near real-time.
  • Customize insights that suit your business needs.
  • Add dashboards to your favorite list to access them quickly.
  • Semantic search capability to make finding a dashboard simple and intuitive.
  • Know what is trending and stay ahead of the competition.
  • Maneuver through different dashboards within an integrated platform.
  • Enhanced security features to make your experience more private.


Explore national and state-level enrollment trends across various segments to uncover how the 2023 AEP compared to previous years.

The dashboard is now live after the trial period. It has been created to help you identify the top 5 counties to focus on expansion. It also allows you to allocate weights (per your requirements) on the network, plan design fitment and demographics while decision making.

It allows you to

  • Understand market dynamics like the demographic composition of target counties, growth rates of different markets/ counties, etc.
  • Analyse the provider landscape to understand your network competitiveness in target counties
  • Identify your plan’s competitiveness/effectiveness by analyzing plan compositions in target counties

Benefit Disruption Report, based on MA Landscape + PBP data, gives you quick access to key benefit changes in the market within 5 days of big release!

The report helps you to:

  • Analyze plan designs at a market level to identify where you and your competitors have risks based on the plan cost metrics and benefits
  • Identify competitor strategies for AEP, be able to identify where you are well positioned and can go aggressive based on a competitor’s risk area
  • Easily identify benefit offerings and cost changes at a plan level

The competitors in this report are segregated into three categories – “National,” “Up-and-coming,” and “Regionals” to help you compare against competitors in your market segment.

The Enrollment Disruption Report was released this year to highlight the 2023 AEP Enrollment Disruptions in the market.

It can help you with 3 quick identifications:

  • Counties that have grown or witnessed abnormal changes (switches) this year …and then look at Market Snapshot to know why
  • Payors and Plans that have disrupted certain counties ….and then look at Plan Finder to understand how?
  • Plan Types that have grown significantly in certain markets …to understand the change in beneficiaries’ preferences

Do you wonder why the enrollment trend graph for an organization shows an abnormal spike or fall?

We have introduced an add-on to our widely used Competitor Analysis Dashboard. The change indicates if a Parent Organization has grown inorganically (By acquiring or merging with another organization).

You can just hover over the interest points to view if there was a merger or acquisition.

While you are looking at your competitors, we have added a feature to aid you with quickly understanding who is growing faster than the county average.

NPI Search helps you find NPIs based on specialty and geography criteria from the overall set of HealthWorksAI Medicare Advantage providers. As a part of continuously enhancing the solution, additional details for each provider have been added to help you find the right providers to add to your networks:

  • Hospital affiliations of a physician
  • Group affiliations of a physician
  • NPI Index to show how valuable the provider is in the market

  • Health System the hospital belongs to
  • NPI Quality Index gives you an indication of how well the hospital performs on quality metrics
  • NPI Value Index takes both quality and cost of care into account to indicate which hospitals provide the highest quality at the lowest cost

In addition, you can now search for physicians in geography based on their hospital affiliations to make sure affiliations align with your in-network hospitals.
Plan Finder now has enhanced coverage of benefits, enrollment details, and quick filters to make it even easier to access and compare features across multiple plans.

  • Flex Card Offerings
    • You can compare flex card offerings for combined benefits in the
    • Benefit Comparison page
    • You can also compare flex card offerings specifically for reduced cost share in the
    • Benefit Comparison page
  • Enhanced YoY Benefits and YoY True Plan Value (TPV)
    • The YoY change in benefits for a span of three years will be available for an expanded list of benefits in Plan Finder
    • YoY TPV will give a view to the change in the richness of benefits offered with a single metric
  • Color-coded benefits
    • Expanded list of benefits to have color coding option (# of benefits going up from ~25 to ~180) to quickly compare your plan with a competing plan to find out what they are offering that you are not!
    • You can change the $ or numeric difference at which you would like to color code the benefits
  • Configurable list of benefits
    • Improve your productivity by having an uncluttered view with no overload of information to sift through. Select which benefits are important for you to see on an ongoing basis from the comprehensive list of benefits available from HealthWorksAI.
  • Optional Supplemental Benefit Packages
    • See all available packages
    • Key information like the package name, coverage, deductible/limit, and premium available
  • Enrollments
    • Quick Filters that allow you to filter plans based on enrollment and enrollment growth
    • Key enrollment data on the Plan Card page
    • Compare enrollment data for plans for selected and all counties on the Benefit Comparison page
  • SSBCI/VBID/UF Benefits – Comprehensive yet easy-to-read comparison of SSBCI/VBID/UF benefits.
    • See all available packages with VBID/UF/SSBCI indicator
    • MC and Non-MC benefits cost share reduction by chronic conditions
    • Additional primarily health-related and non-primarily health-related benefits offered by chronic conditions
    • Quick Filter to identify plans offering SSBCI/VBID benefits for a specific chronic condition
  • Drug Coverage in a Nutshell
    • Key Part D Benefits will now be included in Plan Finder to compare Part C and Part D in a single dashboard. You can now see drug costs by tier, purchase type, coverage phase, and by 30 vs 90-day supply for MAPD plans.
  • Combined Benefit Packages – Usage of combined benefits in plans has shown a sharp upward trend, with only 180 plans offering combined benefits in 2021, 3433 plans offering combined benefits in 2022, and now 4067 plans offering combined benefits in 2023. Given this, we have now included information for combined benefits in the Benefit Comparison grid.
    • See all available packages
    • Key information like benefits covered, max coverage amount across all benefits covered, combined visits, limitations, etc.
    • And more!

“xAI - Benefit Simulator & Scorecards are directly actionable for benefit design leading to competitive advantage for payors”

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