Mercer - Talent. Health. Retirement. Investments
Talent. Health. Retirement. Investments

Our Actuarial & Financial Services

Led by Mike Nordstrom, ASA, our team provides consulting assistance built on actuarial knowledge, consulting experience, and creativity to develop comprehensive solutions for its clients.

With the increased emphasis CMS is placing on actuarial expertise, Mercer is well positioned to assist clients on a variety of topics ranging from traditional capitated rate setting to program development and compliance with these new health care delivery models.

  • Cost effectiveness and budget neutrality analysis for 1915(b), 1915(c), and 1115 waivers
  • Managed long-term care capitated rate setting
  • Health home reimbursement analysis
  • Accountable Care Organization shared-savings target development
  • Financial analysis related to duals integration projects involving Medicaid and Medicare funding
  • Actuarial analysis to support the development of state exchange programs as well as the basic health plan option
  • Cost evaluation of expansion populations, including the expansion of Medicaid coverage under PPACA
  • Focused data-driven efficiency studies related to health plan management of emergency room utilization and potentially preventative inpatient admissions as well as management of pharmacy
  • Health plan reviews for compliance and efficiency benchmarking
  • Financial impact of legislative changes and legislative testimony
  • Policy and program strategy, design, and development
  • Technical assistance sessions, including contract/rate negotiations with health plans
  • Primary Care Case Management program enhancement strategy
  • Identification of efficient provider networks

Actuarial & Financial Services Provided

  • Actuarial Analysis and/or Rate Setting
  • Benefit and Eligibility Change Analysis
  • Contractor Reporting and Monitoring (Financial, Quality, Operations)
  • Data Analysis and/or Benchmarking
  • Disease Management
  • Efficiency Analysis
  • Encounter Data Validation
  • Encounter Reporting and Analysis
  • FQHC and Other Cost Reporting
  • Health Care Reform/Uninsured
  • Health Plan Reviews and/or Compliance Audits
  • Long Term Care/Home and Community Based Services
  • Pharmacy Services (Analysis/Policy)
  • Procurement/Solicitation Assistance
  • Program Implementation
  • Risk Adjustment
  • Waiver and/or State Plan Assistance

  Download our Actuarial Services Fact Sheet

Rate Setting

Actuarially sound capitation rates and rate ranges, with CMS rate approval

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The appropriate analysis and monitoring of your data

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Risk Adjustment

Creative alternatives for full-risk and partial-risk contracting, including stop loss, reinsurance, and risk corridors

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