Ed’s expertise is in group healthcare, with an emphasis on government sponsored programs, (including Medicare and VHA) and health care payer/provider relations. His experience covers a broad spectrum, including providers, payers and purchasers. His consulting assignments have included:
- Evaluation and comparison of provider contracts, including development of the Hospital Evaluation and Comparison System (HECS™) and GlobalRVUs™, Medicare-based contract comparison tools
- Development and review of alternative provider payment arrangements, supporting both providers and payers
- Development of Reasonable and Customary Charge Model
- Comparison of provider reimbursement for contract parity analyses
- Medicare Advantage bid support for both Part C and Part D
- Estimating financial impact of regulatory and policy changes
- Projecting liabilities for claims incurred but not paid
- Preparation and certification of annual actuarial opinions
- Development and implementation of risk adjustment algorithms and relative morbidity analyses
- Projecting contribution rates for Multiple Employer Welfare Arrangements
In addition to his experience in healthcare, Ed also has extensive employee benefits experience with both Milliman and other consulting firms.
