Justin Birrell

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