Adrian’s expertise is in group healthcare, with an emphasis on health plan pricing and predictive modeling. Types of clients he has supported include:
- Hospitals and physician groups
- BCBS and traditional insurance companies
- Managed care organizations (HMO, PPO)
- Large and small employer groups
- Medicare Advantage plan sponsors
- Medicaid, low-income, and uninsured
- Other government programs (e.g., veterans)
His consulting assignments have included:
- Assisting providers in negotiating capitation rates
- Analyzing provider contracts
- Conducting QHP pricing, rate filing, and review
- Pricing individual, small, and large group health plans
- Conducting feasibility studies for entering new markets, such as heath exchanges, Medicare, and Medicaid.
- Reviewing, implementing, and customizing risk adjustment algorithms
- Calibrating risk adjusters for commercial populations
- Providing Medicare Part C and Part D bid support
- Performing commercial payer utilization benchmarking
Product development
- Lead Researcher on loosely managed benchmarks for Milliman’s Commercial Health Cost Guidelines (HCG)
- Lead Developer for Milliman’s Part D Experience Summary Tool (PEST)
- Lead Developer for Milliman’s Risk Adjustment Tool (RAT)
