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Nicholas Johnson

FSA, MAAA
Principal & Consulting Actuary
Seattle, WA, US

Nick Johnson is a principal and consulting actuary specializing in healthcare in Milliman’s Seattle office. He joined the firm in 2009.

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Experience

Nick’s primary expertise is in helping clients understand the financial implications of trends and changes in the healthcare delivery system, particularly in Medicare and dual-eligible populations.

He has worked with a broad range of clients, including health plans, integrated delivery systems, provider groups, reinsurers, and the Veterans Health Administration. He has significant experience in Medicare Advantage, Medicare Part D, Medicaid, commercial, and ACA markets.

Nick’s primary focus areas, including examples of recent analyses, include:

Medicare Advantage / Part D

  • Bid development and certification
  • Product development and feasibility analysis
  • Risk score monitoring, forecasting, and optimization
  • Risk-sharing contract support for health plans and providers

Managed long-term services and supports (MLTSS)

  • Medicaid MLTSS RFP response
  • Nursing home to HCBS transition monitoring
  • Forecasting and analysis of programmatic changes
  • PACE capitation rate setting

Reinsurance and stop loss

Publications

Read their latest work

Article

CY 2025 Medicare Advantage Rate Announcement and final rule: What do Medicaid leaders need to know?

08 July 2024 - by Jessica Bertolo, Annie P Hallum, Nicholas Johnson
We outline the key policy and financial impacts of the 2025 Medicare rules for Medicaid agencies.
Article

Navigating the Intersection of Medicare and Medicaid – Dual-Eligible Beneficiaries

12 April 2024 - by Zachary Fohl, Dean Johnson, Nick Gipe, Annie P Hallum, Jessica Bertolo, Marlene Howard, Nicholas Johnson
We provide an overview of the complexities surrounding the intersection of Medicare and Medicaid, and explore opportunities to better serve dual-eligible beneficiaries.
Article

Key insights into 2024 Medicare Advantage D-SNP landscape

05 March 2024 - by Nicholas Johnson, Annie P Hallum, Nick Gipe
As the Medicare Advantage D-SNP market evolves, MAOs, states, and other stakeholders will need to understand the financial and competitive implications.
Article

Key insights into 2023 Medicare Advantage D-SNP landscape

07 April 2023 - by Nicholas Johnson, Annie P Hallum, Nick Gipe
We present six key insights into the changing landscape for Medicare Advantage’s dual-eligible special needs plans (D-SNPs) for calendar year 2023.
Article

Key insights into 2022 Medicare Advantage D-SNP landscape

01 February 2022 - by Nicholas Johnson, Annie P Hallum, Nick Gipe
We offer key insight on the growing market of dual eligible special needs plans, which enroll beneficiaries who are both eligible for Medicare and Medicaid.
Article

Direct Contracting Duals Model: Medicaid MCOs managing Medicare FFS costs for dual-eligible beneficiaries

08 February 2021 - by Nicholas Johnson, Sam Shellabarger, Annie P Hallum
Centers for Medicare and Medicaid introduced the Direct Contracting entity for individuals dually eligible for Medicaid and Medicare in December 2020.
Article

Direct Contracting Duals Model: Medicaid MCOs managing Medicare FFS costs for dual-eligible beneficiaries

04 February 2021 - by Nicholas Johnson, Sam Shellabarger, Annie P Hallum
This white paper summarizes the new Direct Contracting option that the Centers for Medicare and Medicaid Services introduced in December 2020.
Article

Key insights into 2021 Medicare Advantage D-SNP landscape

18 November 2020 - by Nicholas Johnson, Annie P Hallum, Nick Gipe
What are some key insights into the calendar year 2021 dual eligible special needs plan landscape?
Article

COVID-19 and the future of HCBS

15 September 2020 - by Jill Herbold, Nicholas Johnson
This paper discusses some challenges faced, actions taken, and the impact that the COVID-19 pandemic may have on home and community-based services for years to come.
Article

Observations on the employer stop-loss market

04 August 2020 - by Robert Bachler, Nicholas Johnson, Brian Reed, Mike Hamachek
This paper summarizes the findings from Milliman’s 2020 stop-loss survey.