Caroline Li
FSA, CERA, MAAA
Consulting Actuary
Chicago, IL, US
Caroline Li is a consulting actuary with the Chicago office of Milliman. She joined the firm in 2011.
Experience
Caroline’s primary focus is supporting clients in Medicare value-based payment models, in particular, accountable care organizations (ACOs) participating in the ACO REACH (Realizing Equity, Access, and Community Health) and the Medicare Shared Savings Program (MSSP). Previously at Milliman, she spent many years working in Medicare Advantage, Medicaid, and Long-term Care insurance.
Publications and Presentations
- Co-Author, ACO REACH risk scores: Performance year development, Milliman White Paper. May 2024.
- Co-Author, The retrospective trend adjustment in ACO REACH: What’s new in PY 2024? Milliman White Paper, May 2024.
- Co-Author, Interactions between the CIF and the +/- 3% risk score floor and ceiling in ACO REACH. Milliman White Paper, January 2024.
- Co-Author, Recent changes to ACO REACH financial benchmark methodology to account for PY 2024 fee schedule changes. Milliman White Paper, December 2023.
- Co-Author, Evaluating the financial cost of the asymmetry in the MSSP risk score growth cap. Milliman White Paper, May 2022.
Professional Designations
- Fellow, Society of Actuaries
- Chartered Enterprise Risk Analyst
- Member, American Academy of Actuaries
Education
- MS, Economics, Stern School of Business, New York University
- BS, California Institute of Technology
Publications
Read their latest work
Article
ACO REACH risk scores: Performance year development
29 May 2024 - by Chris Smith, Caroline Li, Anushka Desai
For accountable care organizations using the ACO REACH model of the Centers for Medicare and Medicaid Services, we shed light on normalized risk scores.
Article
The retrospective trend adjustment in ACO REACH: What’s new in PY 2024?
17 May 2024 - by Anushka Desai, Caroline Li
With the retrospective trend adjustment in ACO REACH by the Centers for Medicare and Medicaid Services, we look at what’s new for performance-year 2024.
Article
Interactions between the CIF and the +/- 3% risk score floor and ceiling in ACO REACH
10 January 2024 - by Emma Kramer, Caroline Li
With the Centers for Medicare & Medicaid Services’ ACO REACH Coding Intensity Factor, accountable care organizations face potential financial headwinds for plan years 2023 and 2024.
Article
Recent changes to ACO REACH financial benchmark methodology to account for PY 2024 fee schedule changes
07 December 2023 - by Emma Kramer, Caroline Li, Amanda Snyder
As the CMS Innovation Center revises how the ACO REACH Rate Book handles performance-year fee schedules, we provide average impact estimates at a state level and background information regarding the change.
Article
Evaluating the financial cost of the asymmetry in the MSSP risk score growth cap
10 May 2022 - by Jessica Kildow, Cory Gusland, Emma Kramer, Caroline Li
Milliman evaluated the financial impact of three alternative financial benchmark adjustment methodologies that aim to mitigate the adverse consequence to ACOs.