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:
- Evaluating and comparing provider contracts, including development of the Hospital Evaluation and Comparison System (HECS) and GlobalRVUs, which are Medicare-based contract comparison tools
- Developing and reviewing alternative provider payment arrangements, supporting both providers and payers
- Developing Reasonable and Customary Charge Models
- Comparing provider reimbursements for contract parity analyses
- Conducting Medicare Advantage bid support for both Part C and Part D
- Estimating financial impacts of regulatory and policy changes
- Projecting liabilities for claims incurred but not paid
- Preparing and certifying annual actuarial opinions
- Developing and implementing 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.
