Greg J. Herrle

Prior to Milliman, Greg worked a number of years for a small health consulting firm. His areas of expertise are managed healthcare programs, including Medicaid and Medicare Advantage (Parts A/B and D).

He has also worked with provider organizations to develop utilization and cost benchmark projections and provide fee schedule comparisons. He has also assisted clients in developing custom forecasting and pricing models to fit their specific business needs.

MEDICAID EXPERIENCE

Greg spends significant time working with Medicaid programs, both from a state and managed Medicaid plan perspective. He has assisted clients on multiple Medicaid issues, including:

• Developing and certifying managed care rates or upper payment limits for physical health, behavioral health, PACE, dental, and non-emergency transportation programs
• Establishing strategy around program design, rate negotiations, and contracting
• Developing provider payment rates for physical health and home and community-based services
• Supporting state waiver strategies through cost effectiveness and related analyses
• Implementing risk adjustment models and other risk mitigation strategies in new managed Medicaid programs
• Preparing analyses to respond to Medicaid MCO concerns regarding capitation rates
• Assisting new and existing MCOs in evaluating state Medicaid rates by creating analogous rate ranges
• Attending state rate hearings on behalf of MCOs to better understand underlying capitation rate development assumptions
• Helping local providers understand the implications of the Dual Demonstration

MEDICARE ADVANTAGE EXPERIENCE

Greg also has extensive experience with the Medicare Advantage program. He has spent considerable time consulting to Medicare Advantage organizations, ranging from local start-up plans to large national organizations. Specifically, he has assisted with strategic planning, benefit design, product development and feasibility analyses for new and expanding Medicare Advantage organizations, as well as bid development.

Greg’s prior experience, which included working on behalf of CMS on desk reviews and audits, allows him to provide additional insight to his clients in preparing responses to questions from current CMS reviewers.