Luke B.G. Roth
Principal and Sr. Healthcare Consultant
Seattle, WA, US
Luke Roth is a principal and senior healthcare consultant in the Seattle office of Milliman. He rejoined the firm in 2018.
Experience
Luke has over 15 years of experience providing strategic guidance and transformative solutions to healthcare leaders and policymakers as they navigate the unique risks and opportunities facing their organizations. His primary areas of expertise include:
- Evaluation, design, and rate setting for hospital inpatient and outpatient prospective payment systems, including inpatient DRG-based payment systems, outpatient APC- and EAPG-based payment systems, bundled and episodic payments, and outcomes-based incentive payments.
- Medicaid supplemental payments strategy, including evaluation, design, and implementation of 438.6(c) state-directed payments and FFS supplemental payments.
- Medicaid program funding strategies, including development and implementation of health care-related taxes, intergovernmental transfer (IGT) programs, and certified public expenditure (CPE) programs.
Publications and Presentations
- Author, "State-directed payment considerations for the CMS Medicaid and CHIP Managed Care Access, Finance, and Quality proposed rulemaking." Milliman White Paper. May 2023.
- Author, “Addressing Nursing Facility Financing Challenges During MLTSS Program Development.” ADvancing States MLTSS Institute Report. April 2022.
- Author, “Hospital care for the uninsured in the United States: An analysis of national data sources.” Milliman White Paper. February 2021.
- Author, “Designing payment arrangements for Medicaid providers in response to the COVID-19 emergency.” Milliman White Paper. April 2020.
- Author, “Approved Medicaid State Directed Payments: How States are Using §438.6(c) ‘Preprints’ to Respond to the Managed Care Final Rule.” White Paper. October 2018.
- Member, “CMS Hospital Wide 30-Day All-Cause Unplanned Readmission Measure for Medicaid Beneficiaries.” Technical Expert Panel (TEP). March 2017 to September 2017.
- Author, “Insights for Designing Effective Medicaid Readmissions Policies.” Issue Brief. February 2017.
Education
- BA, Mathematics, University of Washington
Publications
Read their latest work
Article
Policy considerations for designing hospital payment systems for Medicaid programs
18 November 2024 - by Luke B.G. Roth, Mitch Johnson, Sam Heil
We share our key findings from an analysis of care provided to Medicaid patients by U.S. hospitals, using data the providers supplied to CMS.
Article
Simulation of version 40 APR DRG payments
15 December 2023 - by Luke B.G. Roth, Christine Bredfeldt, David Byron, Jeffrey Lin
As a health insurer aims to move to version 40 of 3M’s APR DRG classification system, we calculated standard rates to achieve simulated budget targets.
Article
State-directed payment considerations for the CMS Medicaid and CHIP Managed Care Access, Finance, and Quality proposed rulemaking
12 May 2023 - by Ben Mori, Amanda Schipp, Jason Clarkson, Carmen Laudenschlager, Luke B.G. Roth
We review the essentials for states to consider regarding the proposed changes by CMS for Medicaid and Children’s Health Insurance Program Managed Care Access.
Article
Hospital care for the uninsured in the United States: An analysis of national data sources
24 February 2021 - by Luke B.G. Roth, Jessica Naber, Luke Metz, Nina Nikolova
An analysis of hospital care for the uninsured in the United States shows charity care costs are rising.
Article
Designing payment arrangements for Medicaid providers in response to the COVID-19 emergency
30 April 2020 - by Luke B.G. Roth, Ben Mori, James Pettersson, Joseph Whitley, Carol H. Steckel
While large for-profit healthcare provider entities with existing capital reserves or greater access to capital markets may be able to weather the financial strain caused by the COVID-19 pandemic, other small, rural, or safety net provider entities may require additional support to keep their doors open.
Article
Approved Medicaid State Directed Payments: How States are Using §438.6(c) “Preprints” to Respond to the Managed Care Final Rule
30 October 2018 - by James Pettersson, Ben Mori, Luke B.G. Roth, Jason Clarkson
This paper provides a background on state directed payment arrangements based on our review of §438.6(c) “Preprints” and supporting documentation for arrangements approved by the Centers for Medicare and Medicaid Services as of August 15, 2018.