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.
We assist commercial payers build successful, competitive products while safeguarding against catastrophic experience. As experts in the ACA and large group markets, we work with payers to ensure that they are informed of emerging regulatory and competitive risks in this rapidly changing space.
We help Medicare Advantage organizations develop effective rate designs, while identifying and pursuing opportunities across the program’s control points of risk adjustment, star rating, and care management. We enable clients to identify financial performance as it emerges, and in understanding the underlying basis for financial deviation from expectation.
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.
Governmental and regulatory services
We partner with state and federal regulators in reviewing rate filings and conducting market analyses. We support our regulator partners with our significant resources and long track record of serving the mark.
We assist clients along a spectrum of risk management needs; supporting the completion and filing of annual statutory financial statements; advising employers as they manage their captive insurers; and employing predictive modeling techniques to solve client problems.
STRATEGIC TRANSFORMATION, GROWTH AND RESTRUCTURING
Suppliers need to constantly re-think and transform their business design in order to stay competitive.＋