Adam's work spans actuarial, underwriting, health benefits, reinsurance, medical economics, and provider-payer reimbursement topics. Building and leading specialized, analytical teams for a large, national health insurance carrier gave him substantial and unique experience with trend analysis, provider network cost and pricing, and commercial/ACA market competitive analysis. For the last eight years he has consulted for insurance and reinsurance companies, brokers/consultants, MGUs, provider-owned health plans, state governments, and many types of health service providers and their organizations.
Adam has performed actuarial services for all lines of commercial health business. He has also worked on many other types of coverages, such as dental, vision, hearing, supplemental health and life insurance/reinsurance. His government program experience has included special studies, peer and program reviews on behalf of carriers, and providers who participate in Medicare Advantage and Medicaid. He has also conducted special studies for large state employee/retiree benefit plans on topics such as provider risk, risk adjustment, managed competition, high performance networks, area factors, FQHC utilization, and provider payment benchmarks.
Adam is well versed in carrier and provider payment arrangements, negotiation strategies and how they interact with each other, and how they compete in different situations. For the last 17+ years, he has studied the competitive landscape of carriers and providers in more than 175 cities. He has evaluated payment benchmarks and other key metrics for the major commercial health insurers' networks, many other provider networks, ACOs, and provider-owned health plans, as well as other medical financing schemes, such as healthcare co-ops, health sharing programs and reference-based pricing vendors.
