Rate Filing Review


 
 

The Gorman Actuarial (GA) team has extensive experience in reviewing rate filings for various insurance state departments across the country. GA currently reviews rate filings for health, dental, stop loss, and Medicare plan offerings. GA understands that each state is unique while also recognizing the importance of the federal requirements under the Affordable Care Act. GA has developed rate review templates and rate review manuals for some clients to help facilitate the review. GA works collaboratively with each state to meet the requirements and timelines of that state’s rate review process.

 
 

Actuarial Support for Health Insurance Plans


 
 

The GA team has provided actuarial support to health insurance plans across the country including Massachusetts, Rhode Island, Kentucky, Pennsylvania and Oregon. The actuarial support provided can include rate development, peer review of rate filings, product development, IBNR analysis and review, trend development, and financial forecasting. The actuarial expertise of GA’s team can provide support to health plans of all sizes. In addition, GA’s actuaries have experience working at health plans where responsibilities included rate development, product development, financial planning, provider contracting analysis and trend analysis and each have a thorough understanding of the actuarial function within a health insurer.

 
 
 

Financial Reporting and Analysis


 
 

Gorman Actuarial works with several clients to aggregate and analyze large amounts of health insurance information to create actionable reports and presentations.  This information may come from publicly available data sources along with data received directly from insurance carriers or via the client. GA’s consultants have extensive experience manipulating, summarize and analyzing large amounts of data in an effective and transparent manner to create high quality analytics and reports.

 
 
 

Health Care Policy Modeling


 
 

Gorman Actuarial has conducted dozens of studies for at least ten states to analyze, model and provide strategies to address a wide range of health care policy issues. These issues include the impact of merging and de-merging markets; various aspects of the ACA including new rating rules and influx of uninsured; reinsurance programs and Section 1332 waivers; Medicaid expansion; and high risk pools. GA works with each client to understand the issues and goals specific to that state and can create custom models using publicly available data sources and data obtained from the state or insurance carriers within the state. GA has presented results to stakeholders which include legislators, insurer participants, and the provider community.

 
 
 

Provider Pricing and Payment Reform Analysis


 
 

Gorman Actuarial has broad experience in analyzing commercial hospital and physician prices and provider contracts. GA has worked with several state agencies to calculate an all-encompassing relative price metric, analyze drivers of price variation, and assess impact of various contracting provisions on provider prices. In addition, working with health care policy experts and health economists, GA has developed an analytic framework to analyze the impact of provider and hospital mergers on the markets.

 
 
 

Provider Contract Analysis


 
 

Gorman Actuarial can also provide contracting analysis for physician groups and hospitals.  GA is well versed in value based contracting and global payment contracts and can assist providers in developing budgets that are actuarially sound.

 
 
 

Insurance Market Reporting and Analysis


 
 

Gorman Actuarial works with several clients to aggregate and analyze large amounts of health insurance information to create actionable reports and presentations.  This information may come from publicly available data sources along with data received directly from insurance carriers or via the client. GA’s consultants have extensive experience manipulating, summarize and analyzing large amounts of data in an effective and transparent manner to create high quality analytics and reports.