Emily Vandermause

Emily has served many types of clients in her time with Milliman’s Healthcare Practice. She has assisted in performing actuarial work for Medicare Advantage organizations, employers, insurance companies, brokers, and numerous other healthcare clients. Through her experience she has gained insight into a variety of types of health care coverage, most recently focusing on the Medicare and Medicaid markets.

She has been involved in the development of Medicare Advantage bids since she began at Milliman. She has assisted large organizations in submitting bids for numerous plan offerings with extensive membership, including plans that focus on various special needs populations.

Her Medicare Advantage experience includes the following:

• Development of cost and revenue projections to assist clients in making strategic decisions
• Benchmarking analysis and comparisons to fee-for-service utilization levels
• Analysis of strategic considerations related to service area expansion and the feasibility of new product and benefit offerings
• Analysis of CMS-HCC risk adjustment models and the impact to various special needs populations
• Assistance with Part D settlement and risk adjustment estimates for financial reporting
• Development of bids and supporting documentation to submit to the Centers for Medicare and Medicaid Services (CMS)
• Preparation of responses to questions from CMS reviewers

Emily’s Medicaid experience focuses primarily on developing managed care capitation rates for the acute care program in the state of Wisconsin. She also assists with developing and reviewing financial reporting templates that each of the individual managed care organizations submit to the state to help with encounter data validation.

Emily has also helped with the estimation of reserves and liabilities, premium rate development, retiree drug subsidy attestations, and various other actuarial projections and analyses.

In addition, Emily has been a key contributor to the development and ongoing maintenance of CORAL, a Milliman benefit and cost relativity comparison tool. The web-based tool allows employers, insurance companies, and brokers to evaluate the impact of changing medical and prescription drug plan design features such as deductibles, coinsurance, and copays. It allows users to quickly see the impact those benefit changes have on the plan’s actuarial value and overall cost relative to other plans.