Santa Barbara Actuaries offers a wide variety of actuarial and healthcare consulting services. The list below covers just a few examples of our services. For more specific details, please contact us directly.
Financial Outcomes Evaluation
As the healthcare industry continues to transition from “fee for service” to “fee for value”, the ability to accurately measure the result (or value) of a healthcare intervention is ever-increasing in importance. We have hands on experience in both serving as a third-party evaluator to measure outcomes as well as guiding organizations to stand up their own outcomes evaluation methodologies and protocols based on their needs.
• End-to-end outcomes evaluation services ranging from study design, data analysis, statistical testing, to communication of results
• Assist clients in standing up their own outcomes evaluation capabilities
As the number of shared savings / gain sharing deals increase, many organizations underestimate, or completely ignore, the aggregate amount of financial risk they are taking on. No evaluation method can perfectly account for all random fluctuations caused by factors unrelated to the intervention, thus there is always a non-trivial probability that an outcomes evaluation may produce artificially high gains or losses. We model expected risk levels and payouts associated with different shared savings models to help you make informed decisions when entering shared savings deals.
• Customize shared savings contract arrangements
• Model expected revenue payouts
• Test shared savings design methods
Financial Value Prop Assessment
We bring technical expertise and business acumen to uncover and present the value of your offering using metrics that resonate with your potential customers. With our experience in the healthcare payer market and understanding of what purchasers of healthcare products and services look for, we dig deep beyond the surface to identify and quantify fundamental value drivers with business sophistication and mathematical accuracy.
• Healthcare economic modeling, including mapping of treatment pathways, cost of care calculations, intervention value quantification, and ROI modeling
Good sales and marketing stories are always rooted in data and evidence. We perform opportunity assessment for your healthcare product, service, and intervention and can represent you to defend the value created by your offering in discussions with actuaries and health economists on the other side of the table. We also support research and publication efforts to build marketing capital for your offering.
• Serve as subject matter expert in sales meetings and deal negotiations to defend claims of value creation
• Research and publication support
• Opportunity analysis
Developing a great healthcare product, service, or intervention is only part of the battle; finding and engaging appropriate users to maximize your offering’s potential is equally important. We can help you develop actionable insights through analyzing your customer base and their risk profiles. We frequently build predictive models to identify members who stand to benefit the most from your product, service, or intervention leveraging robust datasets. This can be based on medical cost savings opportunities, clinical improvement opportunities, or other desirable outcomes that you intend to pursue.
• Patient risk stratification
• Predictive analytics, including high cost conditions, readmission risk, ER risk, surgery risk, over-medicalized death, facility wait times, consumer choice
We provide expert opinions on actuarial legal matters. We have supported numerous legal cases and have actuaries on staff with close ties to the academic community.
• Actuarial, financial, and statistical calculation validation
• Attestation write-ups
• In-court witness bearing
General Actuarial Support
We offer a wide range of conventional health actuarial services including health plan rate setting, IBNR Calculations, Claims Analysis and Reporting, Actuarial Cost assessment of Plan Design Changes, RFP Assistance, Risk Adjustment Calculation and Support, Predictive Analytics/Modeling and Statistical Support and Analysis.
• Reserve Development and Actuarial Opinion
• General Pricing/Rate Setting
• Trend analysis
• Risk-based Capital calculations
• Medicare Bid Development and Optimization Support
• MA Revenue Forecasting (Mid-Year and Final Sweep Estimates)
• Data Ingestion (Claims, MMR, MOR, MAO-04, etc.)
• VBC Contract Design and Negotiation Support
• Predictive Modeling and Chase List Development
• Economic (ROI) modeling
• Evaluation of Health Care Interventions
• Claims Analysis and Reporting