Actuarial & Financial
One of our clients’ most important responsibilities is to understand the financial impact of proposed or approved changes to their health care program. Changes may derive from recommended plan design improvements, enacted or proposed state and federal legislative or regulatory actions. For example, GRS has provided clients with the cost impact of various portions of the Affordable Care Act (ACA).
Using our clients’ specific data and experience, we develop actuarial and financial analyses and reporting that assists our clients with both short-term and long-term management of their health care programs. Common deliverables include annual rate setting, budget tracking, cost projections, legislative impact analysis, rate filing reviews, utilization analysis, and Medicare Part D attestations.
Helping plan sponsors determine the types of plans and benefit levels to offer is not only fundamental to the operation of a health care program, but a key determinant of health care spending, utilization of health care services, and the delivery of quality services to plan participants.
Our consultants have advised clients on a wide array of benefit designs and delivery systems such as PPO and HMO plans, fully and self-insured plans, high deductible health plans (HDHP) with an HSA account, cost-sharing strategies, Medicare options, defined benefit and defined contribution funding, prescription drug formularies, pharmacy benefit manager (PBM) programs, cost-sharing options, and public and private exchanges. We are also helping clients pioneer innovative program initiatives related to wellness, accountable care organizations, patient center medical homes, high performance narrow networks, and specialty prescription drug distribution and management models.
Data Management & Analytics
GRS’ approach to delivering services is research based and data-driven. We specialize in delivering evidence-based health care solutions through the development, application, and analysis of clients’ health care data. We have experience constructing client-specific data warehouses, as well as utilizing data that clients may already be housing. We harness the power of your data by venturing beyond data mining exercises. GRS’ approach to data focuses on building actuarial and econometric models that produce insights and validation of financial performance, utilization patterns, and health care quality.
Vendor Procurement & Management
GRS understands that health care vendors are at the heart of health care delivery and a key to the success of any health care benefit program. We work closely with our clients to procure and evaluate vendors’ benefit program offerings and negotiate service levels and financial performance. On an ongoing basis, we track vendor and program performance, assist our clients with operational issues, and manage all aspects of the renewal process.
Legislative & Regulatory Compliance
As clearly evident today, decisions made by Congress and state legislatures have a major impact on the viability of healthcare plans and the economic security of plan participants. GRS consultants help clients examine the likely impact of proposed legislation on health plans, provide information to answer their regulatory and compliance questions, and recommend strategies for complying with the enacted legislation.
Our knowledge of regulatory and compliance issues is furthered enhanced by our relationship with the Groom Law Group, which provides support to GRS on compliance matters. Through this valuable relationship, our consultants become increasingly knowledgeable on compliance matters that our clients face.