// . //  Actuarial // Healthcare
 

What We Do

The healthcare industry faces unprecedented challenges. Confronted by unrelenting, competitive forces in a complex and dynamic market, payers, providers, and regulators must adjust their business practices to address these challenges. We help industry leaders in building and implementing customized actuarial solutions to address the opportunities and challenges they face. 

Commercial

As actuarial experts in the ACA and large group markets, we bring state-of-of the art tools and techniques to our commercial market clients, helping to manage the complex, constantly changing state of the market’s competitive landscape. We deliver insights that help our clients build businesses that succeed over the long term. We work with payers to ensure that they are informed of emerging regulatory and competitive risks in this rapidly changing space.

Medicare Advantage

We assist Medicare Advantage organizations in developing products and rates to support the strategic specific strengths of their own business model. Our pricing teams employ flexible methods so that clients can implement the products they need to succeed without concern for modeling limitations.

Provider

We support providers in identifying and managing risk under new reimbursement arrangements. Because our experience extends across many payers (from Medicare to direct employers) and reimbursement designs (from bundles to capitation), our clients benefit from methods that are tested and empirically based.

Predictive modeling

Our team leverages best in class techniques in machine learning to discover breakthroughs and unlock project potential through predictive modeling and advanced analytics. We have extensive expertise in building and implementing predictive models with healthcare payers.

Regulatory

We are a trusted partner to insurance regulators, empowering informed decisions that enable impactful actions for their health insurance markets. We provide a comprehensive suite of actuarial services, including reviewing rate filings, helping to enhance rate review processes, studying ways to improve affordability for consumers, and analyzing the expected impact of proposed or passed legislation.

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What We Think

Health Insurer Financial Insights, Vol 2

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Potential Impact Of Invalidating The ACA On The Individual Market - 2020 Update

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CMS Part D Senior Savings Model

Considerations for Part D plans on the CMS release of the Part D Senior Savings Model CY2021

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Carrier Trend Report - July 2020

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Evaluating the CMS Proposed Rule to Permit Two Specialty Tiers in Part D

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Who We Are