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    Home  // . //  Health Actuarial Consulting // Financial optimization for healthcare providers
     

    What We Do

    Across the US, healthcare providers are facing increased costs to deliver high-quality care to their patients. At the same time, reimbursement rates are decreasing, and value-based care arrangements that are difficult to attain have become the norm.

    Because value-based investments often take several years to generate returns, providers must connect near-term decisions to multiyear financial outcomes. To do this effectively, they need to harness data to anticipate risk, identify opportunities, and build sustainable financial performance across their operations.

    Drawing on a combination of deep actuarial expertise and advanced analytics capabilities, our team helps provider organizations, including accountable care organizations (ACOs), health systems, physician groups, and clinically integrated networks, optimize their financial performance under value-based and alternative payment arrangements.

    Our actionable insights support growth and ensure sound risk management in a complex, constantly evolving industry.

    Our expertise
    Value-based program and contract strategy
    Evaluate financial performance across Medicare and commercial value-based arrangements to identify the optimal mix of programs, contracts, and risk tracks.
    Actuarial forecasting and financial planning
    Generate forward-looking forecasts with confidence ranges to support budgeting, accruals, reserves, and executive decision-making.
    Risk exposure and capital optimization
    Quantify downside risk, loss reserving needs, and reinsurance options to align financial exposure with organizational risk tolerance.
    Payer contract optimization and negotiation
    Use simulations to assess expected value, downside risk, and negotiating leverage for Medicare Advantage and commercial contracts. Support includes MSSP, REACH, and LEAD.
    Provider-level performance and incentives
    Analyze financial contribution at the provider, practice, and service-line level to support incentive design and distribution strategies.
    Utilization and cost structure improvement
    Identify actionable opportunities across site of care, service mix, utilization patterns, and clinical variation to improve total cost performance.
    Benchmarking
    Build a “digital twin” cohort in the 100% Medicare Advantage Encounter Data, based on similarities, to produce an actionable benchmark to identify strategic opportunities to more effectively manage costs, tailor interventions, and monitor performance relative to peers.
    Data modernization and AI enablement
    Leverage AI tools to mine ACO data to find areas of improvement, participant additions, and outliers.
     

    What We Think

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    Breakthroughs

    ACO turns losses into $30M gain
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    A health-system-owned ACO was experiencing annual Medicare Shared Savings Program losses of approximately $20 million. Using 100% Medicare data, we modeled 5,000 participation scenarios and multi-ACO configurations to guide network optimization. Within two years, the ACO generated more than $30 million in savings and continues to grow by offering competitive savings distributions to new participants.

     

    Solutions

    PRISM framework powers ACO goals
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    Developed to help ACOs reach their business goals, our Programs, Risk, Size, Margins, Funding (PRISM) framework identifies the analysis needed to enable providers’ most impactful financial decisions. 

     

    Who We Are