Overview

The always popular Medicaid Hot Topics session is back with discussions from an expert panel on the most riveting Medicaid topics of the year. These could include the following: 

  • Medicaid Fiscal Accountability Proposed Regulations 
  • Tennessee's Block Grant Proposal 
  • ACA court battles: What are the potential impacts on Medicaid? 
  • Pass-through payments are converting to directed payments: What is changing? 

Medicaid is dynamic and it is difficult to stay current on all of the changes. This session provides insightful discussion into the major changes that impact actuaries and their companies or state clients. 

At the conclusion of this session, attendees will be able to: 

  • Educate their employers and clients on the changes in Medicaid and how they impact them 
  • Evaluate the impacts of the changes on their employers and clients 
  • Create strategies for dealing with the changes that are taking place in Medicaid
Agenda and Speakers

Moderator(s): Sabrina Gibson, FSA, MAAA

Presenter(s): Taylor Pruisner FSA, MAAA; Daniel Schnur, FSA, MAAA; Jaredd Simons, ASA, MAAA; David Wierz

Sabrina Gibson, FSA, MAAA (Moderator)

Sabrina Gibson is a Vice President with Centene Corporation headquartered in St. Louis, Missouri. She is a Fellow of the Society of Actuaries and a Member of the American Academy of Actuaries and has worked as a health care actuary for 23 years and a Medicaid actuary for 13 years mostly with a health plan but also as a consulting actuary. She has experience with 27 Medicaid and CHIP programs in 16 states. Sabrina is a graduate of the University of North Carolina at Greensboro with a major in Mathematics. She is an active member of the American Academy of Actuaries (AAA) Medicaid workgroup and the SOA Medicaid Committee. She was on the committee that developed ASOP 49, participated in several AAA workgroups on actuarial issues related to Medicaid, has presented multiple times on Medicaid and other topics at SOA meetings and in SOA webinars, served as the chair of the POG for the SOA Medicaid Managed Care margin study, and has written several articles for SOA publications.

Taylor Pruisner FSA, MAAA

Taylor Pruisner is a Director and Senior Consulting Actuary with Wakely Consulting. He has over 18 years of experience as a healthcare consultant. Taylor has worked extensively with Medicaid Health Plan Associations and individual Medicaid plans on a wide range of issues such as Medicaid rate development review, evaluation and comparison of programmatic costs, financial analysis and management, population morbidity and trend analysis, and estimation of Medicaid managed care savings. He is proficient in healthcare data analytics and modeling, and has significant knowledge of Medicaid rate development methodologies and associated considerations.

Daniel Schnur, FSA, MAAA

Daniel Schnur is a Senior Director with Centene Corporation. He is a Fellow of the Society of Actuaries and a Member of the American Academy of Actuaries. Dan has 25 years of experience in the health care practice area, with his recent focus on Medicaid plan support and corporate reinsurance risk management. Prior to his plan experience, Dan worked as a consulting actuary supporting Medicare, Commercial and group dental products. Dan is a graduate of the University of Florida with a major in Mathematics and has an MBA from Georgia State University in Atlanta.

Jaredd Simons, ASA, MAAA

Jaredd is currently Vice President, at Magellan Health. Actuarial career spans 14 years in health care, with a focus on Medicaid over the last 8 years. Prior to joining Magellan Health in 2019, Jaredd was a Director at Centene and Principal with Mercer Government Human Services Consulting; Jaredd began his career with Coventry Health Care where he supported Group, Individual, and Medicaid lines of business for multiple states and markets.

David Wierz

Driving revenue & cash flow by applying analytics to create the strategies that define value and secure access, pricing, contracting & payment in care management, digital health and life sciences

David J Wierz delivers strategies that translate value into product and commercial roadmaps. He builds the revenue and business models securing sustainable returns in Care Management, Digital Health & Life Science for early stage to Fortune 50 companies in US & Global markets.

David’s focus is enabling strategy thru execution. Pivotal in his work is improving organizational capacity to achieve the goals of refining clinical outcomes together with strengthening consumer engagement and financial performance. He integrates information and analytics to build evidence that demonstrates comparative clinical, financial and operational gains across providers, manufacturers, payers and consumers. David applies his knowledge of how policy defines payment, care delivery and business systems to enhance managing patients in post-acute and long-term care.

David’s leadership spans US, North American and Global operations in setting commercial strategy, value and payment that integrates digital health (Symptom Control, Biosign, Life Navigator), care delivery (Rockwell Medical, TakeCare, SSM Health), payers (MedImpact) and life sciences (Lifescan, Pfizer, Takada, Baxalta, Novartis Oncology). He currently serves as a Health and Digital Health Reviewer & Portfolio Advisor for Ben Franklin Technology Partners (BFTP) and Dreamit Ventures.

Areas of Expertise
• Strategy – Go-to-Market, Clinical Development & Lifecycle – Technology Assessment, Adoption & Diffusion – Use in Practice, Revenue Model & Business
Model
• Analytics – Clinical, Financial & Operational Optimization – Data Integration, Evidence & Outcomes – Care Path Identification, Evaluation & Improvement
• Value & Payment – Benefits, Effectiveness & Value in Use – Pricing, Contracting & Access – Consumer, Third-Party & Government Activation, Budgeting & Funding

Education
• iMSA – Gies College of Business – University of Illinois – Degree Candidate
• MA (ABD) – Wharton Doctoral Program, The University of Pennsylvania
• AB – The College, The University of Chicago

Honors & Awards
• Incite Award – Biosimilar Franchise Evaluation – Baxalta

Believer that there is poetry in data – That questioning builds curiosity – And curiosity creates solutions

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