The Provider Response to Covid-19

Providers have been impacted greatly by Covid-19, and their future response will impact health-related actuarial pricing and modeling. We will cover the following topics: • Review the current state on how Covid-19 is impacting provider financials by assembling and discussing the latest articles and topics specific to the provider community. This will include a brief overview of the CARES Act provider relief fund. • Explore various pricing pressures such as lost revenue due to Covid-19, volume shifts from private to public payers and lower utilization due to likely future changes in patient patterns (eg. telemedicine). This will also include the new hospital price transparency legislation and the potential pricing pressure from this. • Assess potential impacts on value-based programs, such as CMS Pathways to Success and Direct Contracting, including increased future interest in capitation models.

Bela Gorman, FSA,MAAA

Bela is the president of Gorman Actuarial, Inc., an actuarial consulting firm located in Massachusetts. Bela has over 25 years of health care actuarial experience and has extensive experience in provider payment reform, health care premium and rate development, health care analytics, and health policy. Over the years, Bela has lead dozens of studies analyzing the impacts of various health policies on the insured markets for states across the nation. In addition, Bela has provided consulting services to state agencies to analyze provider reimbursement and provider price variation. Bela also reviews rate filings for various state agencies and provides consulting services to smaller health plans. Prior to starting her own consulting firm, Bela worked for the two largest health insurance carriers in Massachusetts.

Timothy Smith, ASA,MAAA

Partner & Consulting Actuary

Tim Smith is a Partner and Consulting Actuary at Axene Health Partners, LLC (AHP). He leads AHP’s presence in the Pittsburgh area, opening up the firm’s office there in 2015. Tim has enjoyed a 20-plus-year career in clinical and provider analytics and medical economics, working with health plans, health systems and provider groups. Tim held previous positions at Highmark Health and Coventry Health Care. Tim is a frequent speaker on health care, medical economics and provider analytics. He has been an adjunct professor at Penn State University School of Business. He lives in the Pittsburgh area with his wife and two children.

Josh Reinstein, FSA, MAAA

Josh Reinstein is a Consulting Actuary with Milliman, Inc. He has nearly 15 years of health care experience. During that time, he has worked with health insurers, health systems, and provider organizations, helping his clients analyze provider contracts and shared-savings arrangements, and project long-term health care costs. Prior to joining Milliman, Josh worked for OptumInsight. He lives in the Atlanta area with his wife and four kids.