Explore Our Services
Payor Profitability Analysis
When businesses get busy, they drop their lowest-paying clients. This is trickier in healthcare.
Deciding which insurance plans to drop and which to grow into is difficult, but House Actuarial can simplify this decision for your practice.
Insurance plans bring three things to the table:
patients,
their needs, and
a fee schedule,
all of which impact your profitability.
Importantly, not all plans bring in patients who need your services. You see them, the patients that come in for their routine appointments but never need any major work. Some plans have more of these patients than others, and House Actuarial can help you identify which ones.
The interaction between fee schedules and patient needs is complex, obscuring which plans are hurting your profitability. We can uncover these plans, so you can drop them confidently.
-
This service includes:
After an initial consultation, House Actuarial will work with your practice to securely collect the necessary data, in compliance with HIPAA.
We will produce a report on the profitability of insurance plans in your practice and recommendations on renewal decisions.
House Actuarial will provide a one-hour final consultation to discuss the results of our analysis.
-
When you partner with us, we set our prices based on the complexity of your practice:
Starting at $5,000 for practices with 1–3 providers
Starting at $10,000 for practices with 4–8 providers
Starting at $15,000 for practices with 9+ providers
After the initial consultation, we will finalize the pricing based on payor mix and contract complexity.
Dropping plans is a big decision. House Actuarial can give you confidence in making it.
Value-Based Care Opportunity Evaluation
House Actuarial will work with your practice to evaluate a proposal for value-based care, where you are compensated based on outcomes rather than volume.
Most healthcare providers have been offered a value-based contract at one point or another, but have turned it down because:
They’re afraid of being exploited,
They’re concerned about downside risk, or
They can’t assess the reasonability of the offer.
House Actuarial brings clarity to your decision, ensuring you are well-informed before you make any agreements. Then, with value-based care, your practice can benefit from the quality of your services, so you can care more attentively for each patient.
-
This service includes:
After the initial consultation, House Actuarial will carefully review a proposed contract, highlighting any concerning terms.
If the contract is reasonable, we will forecast your profitability under the contract, working with you to collect necessary data, in compliance with HIPAA.
You will receive a report outlining your projected profitability, potential risks, and recommendations on maximizing your benefit under the contract.
House Actuarial will provide a one-hour final consultation to discuss the contents of the report.
-
Due to varying complexity of value-based care contracts, this service is priced hourly. After the initial consultation, we will provide an estimated budget based on your practice’s needs.
Value-based care can feel risky and uncertain. House Actuarial can bring clarity as you pursue it.
Shared Risk Reconciliation Support
House Actuarial will actuarially support you as a health plan reconciles your shared risk arrangements, pays capitation, or pays out quality bonuses.
At the end of every year, health plans reconcile their contracts with providers. They send detailed actuarial reports that involve sections such as:
Baseline costs,
National trends,
Pharmacy adjustments, and
Many others.
House Actuarial has experience with these reconciliations and the consequences of imbalanced actuarial support. The health plan may put a lower trend than you are entitled to, inconsistently exclude services, or fail to adjust for new, expensive drugs that affect your bottom line.
We can support your negotiations, ensuring that your practice's stance is strong.
-
This service includes:
After the initial consultation, House Actuarial will carefully review the health plan’s proposed reconciliation terms.
We will review the contract in comparison with the terms and produce a report outlining the major components of the reconciliation, any concerns with these components, and our estimate of a fair reconciliation.
House Actuarial will provide a one-hour consultation to discuss the contents of the report.
At your discretion, we will then communicate our findings to the health plan.
-
Due to varying complexity of shared risk reconciliations, this service is priced hourly. After the initial consultation and at every step, we will provide an estimated budget based on your practice’s needs.
Health plans are armed with actuaries to get the best results they can from these contracts. House Actuarial can bring that credibility to your practice.
If you're interested in working with us, complete the form with a few details about your project. We'll review your message and get back to you within 48 hours.