Peter Fielek
FSA, MAAA
Consulting Actuary
Chicago, IL, US
Peter Fielek is a consulting actuary with the Chicago office of Milliman. He joined the firm in 2015.
Experience
Peter’s core areas of focus are Affordable Care Act (ACA) pricing, commercial risk adjustment, and provider shared savings arrangements. He also has experience with predictive analytics and data science.
Examples of Peter’s expertise include the following:
- Assisting health plans in several states to prepare individual and small group strategy, pricing, and rate filings
- Working with ACA carriers to complete accurate EDGE server submissions and improve risk adjustment operations
- Developing internal models for risk adjustment analytics, coding improvement, and EDGE server submissions
- Identifying potentially undercoded or overcoded members to optimize risk coding for health plans
- Evaluating provider-shared savings arrangements, reimbursement benchmarking, and projecting claim costs
Publications and Presentations
- Co-Author, ACA risk adjustment management: Higher EDGE-ucation. Milliman Insight, December 2017.
- Co-Author, ACA risk adjustment management: Time to keep score. Milliman Insight, December 2017.
- Co-Author, Has the ACA 'death spiral' kicked the bucket? Milliman Insight, July 2019.
- Co-Author, Estimating ACA risk transfers: it’s a tough job, but someone has to do it. Milliman Insight, February 2021.
- Co-Author, In it for the long haul: Best practices for navigating annual EDGE server submissions, Milliman Insight, December 2021.
Professional Designations
- Fellow, Society of Actuaries
- Member, American Academy of Actuaries
Education
- BS, Mathematical Economics, University of Michigan
- BBA, University of Michigan – Stephen M. Ross School of Business
Publications
Read their latest work
Article
Potential impacts on costs and premiums related to the elimination of prior authorization requirements in Massachusetts
10 October 2023 - by Frederick (Fritz) Busch, Peter Fielek
In Massachusetts, we found that reducing or eliminating prior-authorization programs could lower costs for payers and managed care organizations in the Medicaid and commercial health insurance markets.
Article
The ACA high-cost risk pool: Past results and future pricing strategies
13 September 2023 - by Cameron Gleed, Peter Fielek
As high-cost-risk-pool (HCRP) program becomes a larger component of ACA premiums over time, issuers need to consider the HCRP when developing pricing and strategy.
Article
In it for the long haul: Best practices for navigating annual EDGE server submissions
23 December 2021 - by Jason J. Petroske, Peter Fielek
We share best practices to maximize submissions for External Data Gathering Environment, a requirement under the Affordable Care Act.
Article
Estimating ACA risk transfers: It’s a tough job, but someone has to do it
05 February 2021 - by Peter Fielek, Erik Huth, Jason J. Petroske
This paper aims to provide insights and options for estimating key Affordable Care Act risk adjustment factors and increasing the level of confidence in the projection process.