Services

As the healthcare industry continues to transition from “fee for service” to “fee for value”, the ability to accurately measure the result (or value) of a healthcare intervention is ever-increasing in importance. We have hands on experience in both serving as a third-party evaluator to measure outcomes as well as guiding organizations to stand up their own outcomes evaluation methodologies and protocols based on their needs.

As the number of shared savings / gain sharing deals increase, many organizations underestimate, or completely ignore, the aggregate amount of financial risk they are taking on. No evaluation method can perfectly account for all random fluctuations caused by factors unrelated to the intervention, thus there is always a non-trivial probability that an outcomes evaluation may produce artificially high gains or losses. We model expected risk levels and payouts associated with different shared savings models to help you make informed decisions when entering shared savings deals.

We bring technical expertise and business acumen to uncover and present the value of your offering using metrics that resonate with your potential customers. With our experience in the healthcare payer market and understanding of what purchasers of healthcare products and services look for, we dig deep beyond the surface to identify and quantify fundamental value drivers with business sophistication and mathematical accuracy.

Good sales and marketing stories are always rooted in data and evidence. We perform opportunity assessment for your healthcare product, service, and intervention and can represent you to defend the value created by your offering in discussions with actuaries and health economists on the other side of the table. We also support research and publication efforts to build marketing capital for your offering.

Developing a great healthcare product, service, or intervention is only part of the battle; finding and engaging appropriate users to maximize your offering’s potential is equally important. We can help you develop actionable insights through analyzing your customer base and their risk profiles. We frequently build predictive models to identify members who stand to benefit the most from your product, service, or intervention leveraging robust datasets. This can be based on medical cost savings opportunities, clinical improvement opportunities, or other desirable outcomes that you intend to pursue.

We provide expert opinions on actuarial legal matters. We have supported numerous legal cases and have actuaries on staff with close ties to the academic community.

We offer a wide range of conventional health actuarial services including health plan rate setting, IBNR Calculations, Claims Analysis and Reporting, Actuarial Cost assessment of Plan Design Changes, RFP Assistance, Risk Adjustment Calculation and Support, Predictive Analytics/Modeling and Statistical Support and Analysis.