AI Plan Design Modeling Agent
Automating Benefit Plan Design Modeling with AI
Scenario modeling that handles the complexity
The agent rapidly generates and tests multi-parameter scenarios—deductibles, copays, MOOP levels, coinsurance, site-of-care differentials, and specialty caps—with induced demand and utilization elasticity overlays built in.
AV compliance without the guesswork
Automated workflows encode CMS AV Calculator interfaces and service-category rules to prevent mis-entries, maintain de minimis compliance, and flag when small cost-sharing tweaks push designs outside target metal bands.
Stop-loss and bid artifacts, audit-ready
From member-level Monte Carlo simulations evaluating attachment points and lasers to synchronized PBP and BPT workbooks with rebate allocations, the system produces compliant outputs with full audit trails.
How Cassidy automates this using AI
Step 1: Ingest plan parameters and constraints
The Workflow begins when an actuary submits plan objectives—target AV/metal level, market type (ACA, ASO, MA-PD), premium strategy, MLR guardrails, and stop-loss requirements. Cassidy pulls baseline data from connected sources: claims experience, enrollment files, trend assumptions, and external references like URRT templates or CMS benchmark tables.
Step 2: Build and validate the baseline model
Cassidy structures the benefit design in its modeling engine—mapping deductibles, coinsurance, copays, MOOP, accumulators, and service categories. For ACA plans, it interfaces with CMS AV Calculator logic to validate actuarial value and de minimis compliance. For MA/Part D, it aligns benefit structures with HPMS PBP rules.
Step 3: Run scenario analysis
The agent iterates across plan design variations, modeling induced demand, utilization shifts, and cost impacts. For self-funded plans, it simulates claim distributions at member and group levels, applying specific and aggregate attachment points, lasers, and run-in/run-out provisions. Results surface as side-by-side comparisons with plan paid PMPM, member OOP, and premium indications.
Step 4: Generate compliant outputs
Cassidy produces the artifacts actuaries need: AV calculator printouts, URRT exhibits, BPT workbooks with risk score and DIR assumptions, stop-loss premium analyses, and configuration specs. Each output includes documentation for audit readiness and regulatory filing.
Step 5: Route for review and approval
Completed analyses route to designated reviewers with Human-in-the-Loop controls. Actuaries can approve, request adjustments, or trigger additional scenarios—all tracked with version control aligned to HPMS windows and filing deadlines.
Implement it inside your company
- Hands-on onboarding and support
- Self-paced training for your team
- Dedicated implementation experts
- Ongoing use case discovery
- ROI tracking & analytics dashboards
- Proven playbooks to get started fast
