Health
Today, the healthcare industry is facing a variety of challenges. Perhaps, unlike any other industry in the US, the industry finds itself at a crossroads between investors, regulators, and the court of public opinion. All this is complicated by public, private and not-for-profit entities competing head-to-head for the same customers and revenue. This creates complex challenges for insurers, regulators, policy makers, providers and purchasers. In this current environment, it is more critical than ever to understand the unique characteristics and risks of the many and varied markets.
Our team of health actuaries are the leaders in innovative solutions in the ever changing healthcare environment. We are the trusted advisors to insurers, healthcare providers, government agencies, law firms and regulators. Our clients turn to us for our high-level strategic advice, and our ability to model proposed reforms and respond to changes in regulations on both the state and federal levels.
Services for Commercial Insurers, HMOs, and Blue Cross/Blue Shield Plans
- Product Development and Pricing/Underwriting Support -- Premium rate development, rate filing preparation, pricing process reviews, market assessment and feasibility studies
- Reserving/Valuation -- Reserve estimates, actuarial opinion preparation, process reviews (including control assessments)
- Budgeting/Planning -- Financial modeling and projections, capital and surplus strategy including economic capital modeling
- Mergers & Acquisitions Due Diligence -- Financial and process reviews for acquisition targets
- Provider Network Assessments
- Provider Fee Schedules
- Reinsurance Analysis
- Enterprise Risk Management -- Support the development and assessment of risk management programs and models
Services for Insurers of Managed Medicare and Medicaid Programs
In addition to the services provided for Commercial Insurers, we also provide the following services:
- Medicare Advantage bid preparation in compliance with CMS requirements, as well as reviews of rating processes and financial performance
- Support for Medicaid rate negotiations
- Feasibility studies for entering Medicare and Medicaid markets
- Impact assessments of program changes due to new rules and regulations
Services for Governments
- Assessing and modeling the potential impact of proposed legislation on various stakeholders
- Research and analysis on various topics including premium and cost trends
- Assessment of insurance market for state/product/market segments
- High-risk pool feasibility studies and implementation and operational support
Services for Regulators
- Insurer rate filing reviews including expert witness testimony
- Certificate of need analyses
- Medicare Advantage bid reviews and audits
- State insurance department financial examination support
- Financial analysis for newly formed insurance companies applying for licensing
- Insurer market conduct reviews
Services for Others
- Captive insurance company feasibility studies, implementation and operational support, and annual certifications
- Analysis for associations or groups considering establishing medical programs
- Expert witness services and litigation support to law firms
- Actuarial support for CPA firms auditing actuarial liabilities
- Assessment of regulatory reforms for industry and other groups
