Session: The Actuary’s Role in Payment Reform
Speaker: Juliet Spector, FSA, MAAA

With the goal of more affordable medical spending, there has been continued attention to increasing the value of healthcare through arrangements in which healthcare providers and payers work together through sharing financial risk (i.e., payment reform) to better align incentives to provide quality care at more affordable prices. Although the idea of integrated delivery systems and providers taking on risk is not new, there has been a renewed focus on these value-based arrangements. It is important for stakeholders to understand the elements of these arrangements as well as some of the practical issues and impediments that have determined their past success or failure. The actuary, an expert on risk, can help the provider understand the various risks the provider is taking when selecting a payment model.

Juliet Spector is an actuary in the Chicago-Milwaukee Health Practice at Milliman. She lends actuarial expertise to enable providers to understand a patient-centered quality care delivery system. She develops customized actuarial cost models to allow her provider clients to maximize revenue when implementing changes to reimbursement strategies or capitation rates. She develops customized utilization and cost benchmarks to enable a focus on quality of care and best practices. She has experience analyzing and pricing bundled payments and doing longitudinal analysis of specific disease states.