Actuarial Analytics

We cocreate go-to-market strategies for entering commercial-insurance and government-insurance (for example, Medicaid and Medicare) markets. We also help payers develop new products (for example, high-performance networks).

We improve the risk-adjustment design of our clients’ ACA and Medicare Advantage programs.

We help clients design, price, and improve performance for their commercial- and government-insurance products.

Using our analytical skill set, we can model a broad range of topics, including private-exchange strategies, competitive-payer landscapes, and proposal scenarios, for clients to use in internal capability building.

We size revenue and cost opportunities that will enable organizations to improve margin and reinvest in growth (for example, by reducing medical cost through payment-integrity initiatives for an insurer and by increasing the operational efficiency of a hospital’s operating room).

We provide enterprise-transformation support (for example, in M&A) to help organizations quickly capture new initiatives.

We help clients understand and develop perspectives on legislative reform (for example, new proposals on the Patient Protection and Affordable Care Act [ACA] and changes to the Centers for Medicare & Medicaid Services guidance) for their businesses.

In preparation for an expected request for proposals related to a client’s critical strategic account that represented more than 500,000 administrative-services positions, we conducted an in-depth customer assessment, modeled competitor approaches, and determined win factors.

We led a comprehensive third-party-administrator-industry assessment, including market sizing, growth projections, competitor and tech-disruptor business models, key customer segments, pricing and profitability architecture, and strategic entry options, for a national health insurer.

We developed a sensitivity analysis of a provider’s financial projections across multiple scenarios, which led to a significant reduction of capital commitments over five years while improving the resulting projected asset mix.