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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 (Q2'2024)
Our team analyzes health plan-reported financial data each quarter to understand industry trends. As of June 2024, we observed:
- Industry-wide loss ratios in the first half of 2024 are higher than in previous years, primarily driven by high Medicare Advantage (MA) utilization trends and Medicaid MLRs returning to pre-pandemic levels. The MA space is expected to face continued pressure due to ongoing funding headwinds.
- The Individual market saw significantly higher enrollment following the 2024 Open Enrollment Period as members lost coverage due to Medicaid redeterminations and signed up for ACA plans with enhanced subsidies. There is uncertainty in the market as those enhanced subsidies are set to expire at the end of 2025. If they are not extended, there are significant potential risks and opportunities for plans with an unknown risk pool and rate shock in 2026.
- Steep premium increases due to high medical cost trends continue to push small to mid-size employers to consider non-fully insured models for coverage, such as Level Funded, Group Medical Captives, PEOs, and ICHRAs.
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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