Initiative 18|11 - Managed Care 3.0 Case Studies

This session will take a look at specific examples of innovation in the health care industry that has reduced cost and improved quality. At the conclusion of this session, attendees will be able to: • Identify risks in the examples • Understand why the solutions were appropriate • How they might be incorporated in their own work.

Roy Goldman, Ph.D., FSA, MAAA, CERA President-Elect, Society of Actuaries

Roy Goldman was honored to be elected President-Elect of the SOA in 2019 and, thus, in line to become the 72nd President in October 2020. He is a retired actuarial executive who was a Chief Actuary and/or CFO of two national insurers (Humana and Prudential's Group Business Unit) and two regional health insurers (Geisinger and Mercy Health Plans). He served three years on the boards of directors of the Society of Actuaries and is in his fourth year on the board of The Actuarial Foundation. He recently completed six years as a member of the Health Advisory Panel of the Congressional Budget Office. He has a Ph.D. in mathematics and is a Fellow of the Society of Actuaries, a member of the American Academy of Actuaries, and a Chartered Enterprise Risk Analyst. He has been active in the SOA and Academy in both actuarial education and health policy for most of his 40-year career. He rose to become General Chair of Education and Examinations, where he changed how exams are graded and volunteers trained. He served on committees that developed new ideas such as the Fellowship Admissions Course. He led the committee that developed the new FSA exams and modules for the group and health track; He has published in The Wharton Healthcare Quarterly, Health Watch, Contingencies, The American Journal of Managed Care, and his 1990 TSA article and Disability Study note won an award for best paper on employee benefits. He has spoken at many health and annual meetings of the SOA and has been a spokesperson for the SOA on healthcare issues, such as the Affordable Care Act.

Elaine Corrough, FSA,MAAA,FCA

Elaine is Director, Actuarial Services for Community Health Plan of Washington.

Karen Shelton, FSA,MAAA (Moderator)

Karen is Vice President of Client Analytics at UnitedHealthcare, with more than 20 years of experience in the health care industry. She currently leads a team of actuaries who are responsible for strategic plan design, competitive pricing analysis, and narrow network product evaluation for UHC’s largest customers. Karen is passionate about educating current and future actuaries. She has been an active volunteer with the Society of Actuaries in both education and professional development. Karen has served on as the chairperson of the Health Section, the SOA’s largest special interest section. She also has international experience, having worked in the U.K. for two years and serving on the SOA’s International Education Task Force. Karen resides in Richmond, VA with her husband, Mark, their two children, Hannah and Nathan, and dog Manny.

Sara Teppema, FSA, MAAA, FCA

Sara Teppema is President of Alta Advisers, where she focuses on quantifying the value of population health programs. Before launching her consulting practice, Sara led the design of innovative and value-based payment models at Blue Cross Blue Shield of Illinois, Montana, New Mexico, Oklahoma and Texas. She has over 25 years of health care and actuarial experience, primarily in consulting with a wide variety of clients, including providers, health plans, employers and government entities. She is a member of the Society of Actuaries’ Board of Directors, and she chairs the SOA’s Diversity & Inclusion strategy. She is the past chair of the SOA’s Research Executive Committee, and led a task force as part of the SOA’s Health Section’s strategic initiative for Public Health. She is also on the advisory board of the actuarial program at the University of Illinois at Urbana-Champaign (her alma mater). When she is not involved in work and volunteer activities, Sara spends time with her husband and three young adult daughters; plays music and sings as much as possible; and regularly hikes and practices yoga.

Melissa Chacko, FSA, MAA, EA, FCA

Melissa Chacko is a Director in Buck’s New York Health Practice where she consults on a variety of healthcare related topics with managed care organizations and other health plan sponsors. Melissa also has significant U.S. retirement and Global Consulting experience with large Fortune 500 U.S. multinationals.

Wendy Kwan, FSA, MAAA

Wendy is a Health Actuary at TriNet in New York City. TriNet is a cloud-based professional employer organization for small and medium-sized businesses. As one of the TriNet’s first actuaries, Wendy wears many hats on her team and is involved in pricing, forecasting, and reserving. Tasked with building TriNet’s Actuarial Team in 2016, Wendy was required to innovate several foundational tools, models, and processes to accommodate TriNet’s unique business needs in addition to building the actuarial career path for students.

Prior to her role at TriNet, Wendy was an Actuarial Consultant at Mercer in NYC and Toronto, where she honed her soft-skills in communication. She is experienced in both US and Canadian healthcare industries.

Michael Pacolay, FSA, MAAA

Mike Pacolay is a Fellow of the Society of Actuaries and Member of the American Academy of Actuaries. He has over 10 years’ experience in the health sector, working in areas such as large group commercial pricing and rating, benefit valuation and product design, value-based reimbursement, and integrated delivery system analysis. A health enthusiast himself, Mike believes the current healthcare system needs to transition away from sick-care to focus on measurable health metrics, behaviors and incentivized accountability. He is constantly looking for methods and ideas to meaningfully disrupt the paradigms of both the health insurance and provider landscapes.