Craig M. Arnold, Managed Care Actuary

Services for HMOs and Insurers

 Capitation and reimbursement analysis: I can give you options for balancing your need for fair reimbursements with a package your provider contracting staff can sell.  I can develop capitation arrangements that fit your systems, and also reimburse appropriately.  I can provide your non-technical provider staff with general rate information they can use when communicating with providers.

 Provider contract negotiation: I can help with face-to-face negotiations with providers to work through the numbers.  I can assess your contracts to see if anything has been left out.  Having a knowledgeable actuary (who talks in plain English) on your side of the table can make negotiations much smoother.  In addition, I can advise on how to best implement new arrangements on your current computer system.

 FEHBP (Federal Employees Health Benefit Program - the HMO option): I can assess your likelihood of being audited, the amount you have at risk, and help defend you in case of an audit.  If you get an audit letter from OPM (Office of Personnel Management), call me ASAP.  This is a niche that I specialize in - ask me about my presentation to the Society of Actuaries.

 Reserving / IBNR: I can ensure that you are properly reserving for changes in types of contracts (e.g. more capitation) and changes in products.  Many insurers have made one-time adjustments for these types of changes, but lack a consistent, fluid methodology that will adjust automatically over time.  I can provide you with a clean solution that will not overwhelm you with details.

 Reinsurance: Have your reinsurance and provider stop-loss arrangements been seriously reviewed to assess their appropriateness?  What about interactions with your capitated arrangements?  I can give you a clean overview and provide solutions so that you are not undercovered or, more likely, overspending on double coverage or low limits.  Let me help with your RFP process, to match you with the right broker and coverages.

 Small Group Reform: I can assist with all aspects of Market Conduct Exams (actuarial and non-actuarial).  Ask me about my extensive experience in this area.

 General data analysis and data mining: I can locate your data problems, and work with you to create robust solutions.  I specialize in creating tools you can use.

 

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