Today, the healthcare industry is facing unprecedented challenges. Spurred by unrelenting, competitive forces in a complex and dynamic market, payers, providers, and regulators are being forced to adjust their business practices to address these challenges. Our actuaries assist industry leaders in building and implementing customized solutions to address the opportunities and challenges they face.
Commercial Insurers
Oliver Wyman assists commercial payers build successful, competitive products while safeguarding against catastrophic experience. Our actuaries are experts in the ACA and large group markets, and we work with payers to ensure that they are informed of emerging regulatory and competitive risks in this rapidly changing space. Commercial payers rely on our custom-built tools to facilitate accurate and seamless experience analysis, underwriting, rate development, and experience and financial reporting.
Government Programs
Oliver Wyman’s Actuarial Practice helps Medicare Advantage organizations develop effective rate designs, while identifying and pursuing opportunities across the MA program’s control points of risk adjustment, star rating, and care management. We serve clients in identifying financial performance as it emerges, and in understanding the underlying basis for financial deviation from expectation.
Providers
Oliver Wyman supports providers in identifying and managing risk under new reimbursement arrangements. Because our experience extends across many payers (from Medicare to direct employers) and reimbursement designs (from bundles to capitation), our clients benefit from the assurance that our methods are tested and empirically based. We have assisted with contracting with payers, financial modelling, and liability estimates.
Services for governments and regulators
Oliver Wyman serves as partner to both state and federal regulators in reviewing rate filings and conducting market analyses. Our regulator partners are supported by a large firm with significant resources and a long track record serving this market; there are few situations that we have not encountered.
Other services
In addition to the core services identified above, we assist our clients along a spectrum of risk management needs with our empirically focused methods. We support the completion and filing of annual statutory financial statements; we advise employers as they manage their captive insurers; and we employ predictive modelling techniques to solve client problems.
