Risk Adjustment in the Health Industry

Andrew Gottschalk, ASA, MAAA

Risk adjustment is used in multiple health insurance markets as an attempt to compensate carriers for the relative cost difference in a population’s underlying health status. This session will explore foundational risk adjustment concepts, models and financial implications of how risk adjustment is used in practice. Topics will include the impacts of risk adjustment transfers on pricing, reserving and health plan operations.

Andrew Gottschalk is a Manager at the Chicago office of PwC’s Health Care Consulting Practice. He has worked with a range of clients including payers, providers, as well as federal and state regulators. His primary interests include pricing for commercial and Medicare Advantage plans, as well as rate setting considerations in Medicaid. More recently, he has lead multiple risk adjustment engagements focusing on risk score improvement.

Andrew graduated with honours from the University of Western Ontario. He is an Associate of the Society of Actuaries and a member of the American Academy of Actuaries.

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