Tammy Tomczyk is an actuary specializing in health insurance consulting. Tammy provides consulting services to state and federal regulators, health plans, and health care providers. Having provided actuarial consulting services for over 25 years, Tammy’s expertise includes product development and pricing for many types of managed care and traditional plans, Medicare Advantage pricing, reserve analysis, development of provider capitation rates, trend analysis, review of filings for state insurance departments, fee schedule analysis, financial management and forecasting, underwriting process reviews, risk adjustment, and legislative analysis.
Tammy is heavily involved in healthcare reform and is considered an industry expert on the Affordable Care Act (ACA), specializing in the individual and small group markets. In addition to assisting health plans in the development and pricing of ACA compliant products, she has assisted states in studying their options under Section 1332 of the ACA and preparing actuarial projections based on microsimulation modeling to support Section 1332 Waiver applications. She has also assisted states by performing modeling to analyze the impact of proposed changes to the ACA, helped them enhance their rate review processes to achieve effective rate review status, and previously performed many studies to assist states in the planning and development of state based exchanges. Tammy is co-author of the practice’s healthcare reform microsimulation model and oversees the practice’s commercial pricing models.
Tammy's professional experiences include:
• Assisting health plans develop pricing and product strategies for the post-2014 reformed market
• Assisting provider in analyzing total cost of care risk sharing arrangements
• Assisting several states plan for the implementation of state based Exchanges
• Assisting states study options and submit Section 1332 Waiver applications
• Assisting CCIIO in the development of the rate review requirements for the federal fallback Exchanges
• Assisting health plans and providers analyze the impact of various reimbursement arrangements
• Pricing, preparation, certification and audit of Medicare Advantage Part C and Part D bids
• Co-author of Oliver Wyman’s Healthcare Reform Microsimulation Model
• Overseeing the development and maintenance of the Practice’s commercial pricing models
• Analyzing and development medical fee schedules
• Performing cost and utilization benchmarking studies of healthcare claims costs
• Performing comprehensive reviews of new business and renewal underwriting strategies, including the development of merit underwriting models
• Reviewing health filings for several state departments of insurance
Tammy is a Fellow of the Society of Actuaries, a member of the American Academy of Actuaries, and a Fellow of the Conference of Consulting Actuaries.