Health and Welfare
Rudd and Wisdom, Inc. provides a complete range of actuarial and management consulting services to sponsors and administrators of large group insurance programs, purchasers of group insurance and public insurance programs. We currently serve as the consulting actuary for many of the largest health care programs in Texas. We serve as consultants to insured and self-funded plans and we have special expertise in public insurance programs and plans offered through trade and professional associations.
Our services in the health and welfare field include the following:
- Design of new plans and modification of existing plans to meet employer/employee objectives within the constraints of financial capability.
- Analysis of the effectiveness and efficiency of existing plans both with respect to financial impact and satisfaction of participant needs.
- Evaluation of benefit alternatives.
- Evaluation of legislative impact.
- Assistance in decision-making regarding insurance versus self-funding.
- Consideration of issues related to internal versus external administration.
- Developments of specifications for insurance and reinsurance, pharmacy benefit management (PBM), administrative services and managed care arrangements.
- Evaluation and selection of insurance, reinsurance, pharmacy benefit managers, administrative services and managed care arrangements.
- Carrier negotiation.
- Contract drafting and negotiation.
- Design of alternate funding mechanisms.
- Preparation of actuarial cost projections and statistical models.
- Development, maintenance and management of health and welfare plan data bases.
- Design of statistical reports for health and welfare plans.
- Determination of contribution rates and liability estimates for self-funded plans.
- Negotiation of insurance rates.
- Preparation of budget and cash flow analyses.
- Design and analysis of claims audits.
- Review of utilization and cost patterns and development of trend projections.
- Communication of complex actuarial and risk-related issues to plan sponsors and participants.
- Assistance in preparation of communication tools, including plan announcements and booklets.
- Participation in seminars designed to explain plan provisions and answer questions.
- Assistance to private and public entities in communication and interaction with legislative and regulatory bodies.
Provider Reimbursement Strategies
- Analysis of various approaches for provider reimbursement including: DRG, per diems, discounted fee-for-service, capitation, risk and fee schedule arrangements.
- Analysis of pharmacy reimbursement methodologies and pricing of prescription drug management services.
- Analysis and development of contribution strategies.
- Design of regionalization and risk adjustment methodologies for managed care contributions in multiple plan environments.
Other Post-employment Benefit (OPEB) Liability Determinations
- Selection of assumptions and methodologies related to and preparation of GASB 74 and 75 and FASB ASC 715 (formerly known as SFAS No. 106).
- Assistance with development of strategies for OPEB liability management.