Justin Birrell

FSA, MAAA

Principal & Consulting Actuary

Seattle, WA, US

Justin Birrell is a principal and consulting actuary with Milliman’s Seattle office. He joined the firm in 1995.

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Experience

Justin has more than 20 years of actuarial experience with a variety of health-related issues. His primary focus over the last 15 years has been Medicaid. This has involved work for states including Hawaii, Idaho, Nevada, Utah, Washington, and Vermont, as well as non-state clients where he has supported Medicaid populations in Kentucky, Arizona, Georgia, and Massachusetts. He has worked on a variety of projects, including medical, long-term care, behavioral health, transportation, disease management, procurement, healthcare reform, and other state-specific analyses. In addition to the development of capitation rates, Justin has worked with states to negotiate final rates and produce required CMS documentation.

His experience includes:

Working in multiple states to develop rates and an appropriate structure that integrates both the Medicare and Medicaid component of costs into a single rate for members eligible for both programs
Developing rate structures for integrated (medical, mental health, chemical dependency, and long-term care) healthcare models for Medicaid recipients that improve healthcare and reduce expenditures, including CMS documentation of rates and rate structures
Developing and documenting Medicaid capitation rates in multiple states for managed care services for TANF, aged, blind, disabled, and other unique Medicaid populations, including those eligible for Medicare and those only eligible for Medicaid benefits
Documenting cost effectiveness for Medicaid programs
Risk adjusting Medicaid capitation rates
Developing non-emergency transportation rates for Medicaid populations
Analyzing large claims databases and healthcare modeling
Developing prescription drug formularies
Conducting Medicaid disease management financial savings analyses and analyses of soundness of disease management rates
Working with state agencies to project the impacts of benefit and enrollment changes, including the impact of PPACA legislation on state expenditures
Designing and evaluating pay-for-performance incentives in Medicaid-managed care programs
Assisting the State of Washington in its SIM grant proposal
Making projections of expenditures for Medicaid expansion in Washington, Hawaii, and Idaho

Professional Designations

Fellow, Society of Actuaries
Member, the American Academy of Actuaries

Education

BS, Mathematics, Brigham Young University

Affiliations

Member, Society of Actuaries
Member of the American Academy of Actuaries

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Publications

Read their latest work

Article

Building blocks: Block grants, per capita caps, and Medicaid reform

31 January 2017 - by Brad Armstrong, Justin Birrell, Jennifer L. Gerstorff, Nicholas Johnson

Understanding the implications of Republican Medicaid reform proposals requires consideration of several factors.

Experience

His experience includes:

Working in multiple states to develop rates and an appropriate structure that integrates both the Medicare and Medicaid component of costs into a single rate for members eligible for both programs
Developing rate structures for integrated (medical, mental health, chemical dependency, and long-term care) healthcare models for Medicaid recipients that improve healthcare and reduce expenditures, including CMS documentation of rates and rate structures
Developing and documenting Medicaid capitation rates in multiple states for managed care services for TANF, aged, blind, disabled, and other unique Medicaid populations, including those eligible for Medicare and those only eligible for Medicaid benefits
Documenting cost effectiveness for Medicaid programs
Risk adjusting Medicaid capitation rates
Developing non-emergency transportation rates for Medicaid populations
Analyzing large claims databases and healthcare modeling
Developing prescription drug formularies
Conducting Medicaid disease management financial savings analyses and analyses of soundness of disease management rates
Working with state agencies to project the impacts of benefit and enrollment changes, including the impact of PPACA legislation on state expenditures
Designing and evaluating pay-for-performance incentives in Medicaid-managed care programs
Assisting the State of Washington in its SIM grant proposal
Making projections of expenditures for Medicaid expansion in Washington, Hawaii, and Idaho

Justin Birrell

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Experience

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Read their latest work

Building blocks: Block grants, per capita caps, and Medicaid reform

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Justin Birrell

Experience

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