Health Insurance Consulting
Financial Analysis for Health Insurers
ARC assists independent auditors with a series of insurer audits involving life, annuity and health insurance lines. On the health side, these audits often include nontraditional government programs, such as Medicare Advantage and managed Medicaid. In addition, Affordable Care Act-compliant blocks of business require review of provisions such as ACA Risk Adjustment, Medical Loss Ratio development and MLR premium rebate estimation. ARC’s health staff can assist both auditors and carriers in evaluating and managing the impacts of all these programs.
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Mr. Miller’s experience includes twelve years as Chief Actuary of a Blue Cross Blue Shield plan that was active in a variety of fully-insured and self-insured markets, from individual, Medicaid and Medicare programs to all sizes of group health plans. Included in that background is extensive product development work, from overall strategic considerations to specific plan design elements. At ARC, we have assisted clients in introducing new programs, maintaining existing ones and evaluating newly-acquired blocks of business.
Health Plan Strategy and Analysis
Self-funded plan sponsors often require actuarial assistance in understanding their healthcare trends, benefit design change impacts, employer contribution strategies and future cost projections. ARC has performed each of these functions for healthcare provider entities and a multi-union trust.
In these projects, we paid careful attention to multi-tiered benefit designs, in order to identify potential areas of inappropriate utilization risk. We also analyzed the client’s internal cost trends against national figures, with special focus on the distribution of medical costs by category, particularly prescription drugs. Additionally, we reviewed provider network issues in terms of both discounts achieved and overall utilization rates. Finally, we evaluated eligibility and contribution issues, and the results of these analyses allowed us to make a reasonable projection of future year medical claim costs.
Regulatory and Legal Work
ARC has regularly provided rate filing review services for a state insurance department across a wide range of health insurance lines, including ACA-compliant individual and small employer products, ACA transitional programs, Medicare Supplement, long-term care, dental, vision, disability (STD and LTD), accident, and illness/disease. This experience has positioned us well to provide skilled analysis of damage claims in multiple lawsuits involving health insurers.
Our standard procedure has been to agree with the regulator on the scope of each review, so that duplication of effort is minimized and total cost controlled. This is usually done with a checklist of items to be examined, as applicable. Then we establish a mutually-agreeable template for the report to be sent after each review is completed, which includes the appropriate regulatory references. When objections are necessary, they are clearly stated so that the department can clearly communicate them to the insurer.
ARC has provided actuarial insight and analysis for a variety of health insurance related cases.