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Our Health Actuarial & Economics team delivers outcome-focused solutions to the healthcare industry’s complex challenges. We utilize our expertise in actuarial science, health economics, and data analysis to help clients understand and manage their financial performance. Our team serves clients across the healthcare ecosystem, including payers, providers, and health services companies. We collaborate closely with our strategy and operations-focused colleagues to develop practical solutions for differentiated performance.
Latest Healthcare Trends (Year-End 2023):
Each quarter, our team analyzes health plan reported financial data to understand industry trends. As of year-end 2023, we observed:
- In recent years, Medicaid and Medicare Advantage (MA) have propelled health plan growth. However, those segments will face margin headwinds in 2024 due to redeterminations/rate adjustments (Medicaid) and the new V28 risk adjustment model (MA).
- With healthy groups increasingly seeking coverage through alternative funding products, Group-focused health plans are under mounting pressure to maintain competitive pricing. This pressure requires health plans to explore innovative methods to manage risk pools, such as level-funded and narrow network products.
- National health plans hold a firm grip on market share and margins in the Individual segment. Medicaid eligibility redeterminations further support that National plan strategy, driving additional Individual growth.
Interested in receiving more detailed quarterly updates with the latest industry trends? Get in touch using the form below.
- Product Strategy
- Organization & Operational Excellence
- Performance Management
- Regulatory Compliance
- Financial Reporting & Capital Management
- Audit Support
Product Strategy
Provide insights on product and pricing, supported by market intelligence data / tools
- Competitive market analysis
- Financial modeling
- Product design
- Pricing / Rate review
Organization & Operational Excellence
Establish and reinforce sound organizational infrastructure and interaction
- Risk adjustment
- Pricing & underwriting
- Reserving
- Financial forecasting
Performance Management
Monitor financial performance and identify opportunities to improve margin and affordability
- Claims analytics & use cases
- Reporting & dashboarding
- Value based contracting
- Affordability
Regulatory Compliance
Facilitate compliance with US and global regulations, avoid/mitigate costly penalties/sanctions
- Enterprise risk management
- Medical loss ratio / Quality improvement
- Financial program requirements
- Mental health parity
Financial Reporting & Capital Management
Overall financial reporting support, across actuarial and accounting, and earnings adjustments
- Reserving
- Actuarial opinions
- Capital management & strategy
- Actuarial due diligence
Audit Support
Assessment of financial reporting to support audits
- Health payer financial audits
- Risk bearing provider financial audits
- Group Life / Disability financial audits
- Internal audit support
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