Health Actuarial – Health Plan Services

Business-based insight into the things you can’t know yet.

Reform and other changes in the health care market are transforming the nature and distribution of risk. Analyzing, understanding and managing risk, requires industry-specific knowledge with the most up-to-date analytics capabilities.

For example, setting premium rates has never been simple. Doing so in the new exchange environment, without the information typically used to set premium rates, will likely be especially complex. A pricing error of 1% might represent 50% of your potential profits. Actuarial services may provide value in many areas beyond traditional rate-setting. Actuaries can analyze the potential impact of the ICD-10 coding change, or determine the assumptions you should make in designing a value-based care system. In addition, there is new data that actuaries are working with which allows them to examine how lifestyle-based analytics can help assess and engage potential customers in a retail environment.

Deloitte Consulting LLP’s Health Actuarial Services team, one of the world’s largest, uses technical and benchmarking tools similar to what you’ll see elsewhere in the industry—but only as a starting point. We work with industry specialists from our Health Plan strategy, operations and technology practices to bring wide-ranging solutions to our clients. We focus on collaboration to build tailored, sophisticated models to facilitate your ability to answer the right questions and then develop a fact base that helps you make critical decisions supported by data. Health plans can take advantage of actuarial services in areas such as:

  • Pricing and product development, including exchange pricing based on predicted medical costs
  • Financial performance, such as analyzing provider contracts and effectiveness of medical management
  • Financial valuations and transactions, such as estimations of insurance liabilities and valuation of companies or blocks of business
  • Transforming data into information, making disparate data into meaningful intelligence which may be used throughout an organization
  • Value-based care support, such as economic value analysis models, benchmarking and payment models

Our actuarial approach draws upon America’s largest and most widely accepted claims database, actuarial tools and marketing based datasets. Analytics translates the data into tailored solutions unique to each plan and each situation, including pricing, reserve setting, ICD-10 coding impact, risk adjustment, medical management and lifestyle-based analytics, to name a few.

Our comprehensive actuarial services can provide actionable information, yielding more valuable results. The expected benefits can include improved margin, a more precise approach to medical loss ratios and improvement in your ability to avoid negative surprises.

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Jim Whisler, Principal, Deloitte Consulting LLP


As used in this document, "Deloitte" means Deloitte LLP and its subsidiaries. Please see for a detailed description of the legal structure of Deloitte LLP and its subsidiaries. Certain services may not be available to attest clients under the rules and regulations of public accounting.