Horman Actuarial Solutions is a consulting firm committed to applying complex mathematical, actuarial, and data techniques to practical business problems. Support insurer clients in wide range of projects including rating, forecasting, network design, entering new markets, and trend analysis. Supports multiple ACOs in Commercial, Medicare, and Medicaid with risk contract operations, including building funds flow distribution approaches, interpreting results, supporting negotiations with health plans, and educating senior management on risk contracting. Regulatory compliance services for health plans and providers including the development of compliance databases, systems, and testing plans/processes.
Value-Based Payment (VBP):
• Best practice review of regional health plan value-based contracts. Developed a strategy around variations in provider size, education of providers, development of contract language, and reporting requirements.
• Built a care management evaluation process for a dual plan to understand the financial impact of various care management and risk opportunities. Built pre-implementation evaluation tools, creating guidelines on data tracking, and design of post evaluation statistical studies. Evaluated multiple cost savings initiatives, including a hospice risk program.
Owner & Regulatory Specialist
39 Horace Street
Needham, MA 02494