Kimberley K. Hiemenz

Kim has extensive experience with managed care payment structures, including shared-risk and population-based payment arrangements. She has worked with the Medicare fee-for-service ACO programs, as well as commercial, Medicare Advantage, and Medicaid reimbursement arrangements.

Kim also provides financial and strategic risk management support to insurance companies and health plans. She assists clients with several facets of their business, including product development and pricing, experience analysis, valuation of reserves, financial reporting, and development of risk sharing arrangements. Kim is very well versed in the Affordable Care Act (ACA) and understands the strategic and financial implications of the ACA.

Further, she assists clients with Medicare Advantage feasibility studies and bid development. Her current Medicare clients span a variety of covered populations and benefits.

Kim’s clients include integrated delivery systems, hospitals, health plans, including provider-owned health plans, and Associations/Trusts.

Prior to joining Milliman, Kim had more than six years of experience working for two large insurance carriers, where she focused on pricing, experience analysis, and special initiatives, such as broker compensation programs.

Examples of Kim's engagements include:

• Developing risk-based reimbursement models, including financial projections under various scenarios
• Assessing co-management agreements
• Conducting strategic analysis and payer contracting strategies
• Preparing commercial hospital payment rate comparisons
• Pricing ACA products
• Leading the development of a rating model for a large trust
• Making pro-forma projections
• Developing customized utilization and cost benchmarks
• Conducting Medicare Advantage and Medicare Part D feasibility and bid preparations for multiple organizations, including a special-needs plan