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.
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.
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.
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.
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.
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.
Financial & Capital Management
We can help you understand your current financial state by analyzing your reserves, explaining your historical financial performance, and benchmarking your performance metrics versus your competitors and the industry. We will utilize our projection and capital models to help you understand your risks and your potential future operating results. Proper capital management is critical in light of your current and future risks in and everchanging industry.
We provide actuarial services to support the implementation and management of captive insurance companies. Our experience with captives extends across a broad spectrum of risks including employee benefits, provider stop loss and insurer excess of loss. We strive to assist companies to maximize the efficiency and effectiveness of their risk management programs.
We assist managed Medicaid entities evaluate and understand the risk associated with the various aspects of these programs and the characteristics of their own populations. We support our clients with their capitation rate negotiations, provider contracting and incentive programs, population management including risk adjustment revenue optimization, and financial management to help them manage financial risk/return dynamics.
The health insurance market must continually respond to the regulatory agencies and legislative bodies that monitor and influence the market. We work with all stakeholders in the market to interpret and analyze important changes to the environments in which our clients operate, and we provide a valuable, independent voice to the conversations about policy.
Ancillary Product Lines
Supplemental health products have become an important piece of how individuals manage financing their healthcare needs. We have extensive experience with pricing, product strategy and financial management of products that compliment major medical coverage. We work with products such as: accident, critical illness, fixed indemnity, and dental.＋
What We Think
Conjoin by Oliver Wyman Actuarial is a tool that maximizes profitable demand for specific brands and markets.
We use Conjoin to enable powerful analytics for any potential scenario and be able to know which benefits members prefer in their Medicare Advantage plans.