Adrian L. Clark

ASA, FSA, MAAA

Principal & Consulting Actuary

Seattle, WA, US

Adrian Clark is a principal and consulting actuary with Milliman. He joined the firm in 2007.

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Experience

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)

Publications and Presentations

Publications

Risk score impacts of the Medicare Advantage 2018 RxHCC risk score model update (with David Koenig). Milliman Insight June 2017
Design and Implementation Considerations of ACA Risk Mitigation Programs (with Jim O’Connor). Society of Actuaries Research Report
The Medicare Advantage 5-Star Rating Program and Its Implications for Actuaries (with Gabriela Diequez and Brad Piper). Issue 69 May 2012 Health Watch – Society of Actuaries

Professional Designations

Fellow, Society of Actuaries
Member, American Academy of Actuaries

Education

BA (with distinction), Economics, Mathematics, and Philosophy, University of Colorado – Boulder

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Publications

Read their latest work

Article

Independent review of Wider Circle's methodology for quantifying financial and healthcare utilization impact of the Connect for Life program

14 June 2023 - by Austin Barrington, Adrian L. Clark, Meng Sun, Sam Yih

We review one company’s approach to quantifying the potential impacts of its community-focused healthcare program.

Article

Model change impact on the Medicare Advantage 2020 RxHCC risk scores

23 May 2019 - by Adrian L. Clark, David Koenig

This paper summarizes the changes in member risk scores resulting from the revised Medicare Part D risk score model for payment year 2020.

Article

Risk score impacts of the Medicare Advantage 2018 RxHCC risk score model update

06 June 2017 - by Adrian L. Clark, David Koenig

The Centers for Medicare and Medicaid Services finalized a Part D risk score model for payment year 2018, and the impact will vary based on demographics.

Experience

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)

Adrian L. Clark

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Experience

Publications

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Read their latest work

Independent review of Wider Circle's methodology for quantifying financial and healthcare utilization impact of the Connect for Life program

Model change impact on the Medicare Advantage 2020 RxHCC risk scores

Risk score impacts of the Medicare Advantage 2018 RxHCC risk score model update

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Adrian L. Clark

Experience

Publications

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