I’ve been surrounded by healthcare providers for my entire life. My mother is a dentist, and many of my friends and family are nurses and doctors. Each and every one of them has said the same things about their interactions with insurance companies. They all felt like:

• They don’t have any control over their compensation,

• They can’t do what’s best for their patients, and

• Health plans have convoluted rules that don’t make sense.

So I went into actuarial science, the study of management of risk, ready to use math and data to make things better. I started work at AHCCCS, Arizona’s Medicaid agency. I saw sponsors, health plans, and providers speaking different languages past one another, feeling frustrated and misunderstood. I saw states and health plans work together on sophisticated pharmacy formularies, which they didn’t communicate to providers. And I saw providers hesitate in participation in quality payments and shared savings for fear of being exploited.

From working on Medicaid, I moved to working directly for a nation-wide health provider. This provider works with health plans on value-based care, sharing in savings generated from efficient, high-quality care that puts the patient first. Immediately, I saw the barriers that prevent smaller providers from negotiating with health plans. The company had a large team of dedicated actuaries processing data, forecasting trends, and making adjustments. And the health plans listened to us, largely because we knew how to prove our value to them.

All providers should be compensated fairly for their services, whether it’s fees for their services, capitation arrangements, or value-based care. This is why I founded House Actuarial: to bring the same level of analytical clarity and negotiation strength to providers of all sizes.

JD House, ASA, MAAA