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Gordon R. Trapnell
Gordon R. Trapnell, President of Actuarial Research Corporation, is a nationally recognized expert in analyzing the feasibility and estimating the cost of private and public insurance programs. He has prepared numerous cost estimates for major new federal insurance initiatives that have provided the data needed by public officials to reach important policy decisions and have served as the basis for evaluating the major national health insurance proposals developed by the Administration and the Congress during the last two decades. His estimates are currently being used to analyze the impact of proposals to reform small group and individual health insurance markets.
Mr. Trapnell also has extensive experience in analyzing the actuarial problems of existing public sector insurance and employee benefit programs. He has been retained by the Congressional Budget Office, each Administration for two decades, and a variety of other interested parties ranging from the Committee for National Health Insurance (AFL-CIO affiliate) to the American Medical Association to analyze the cost and financial impacts of major proposals to change the financing of U.S health care. He also has extensive experience in analyzing public sector health insurance programs such as Medicaid and Medicare.
Mr. Trapnell also maintains a private consulting practice, Gordon R. Trapnell Consulting Actuaries (GRTCA), for private health insurance programs, rate setting by HMOs and other managed care organizations, the cost of prescription insurance programs and long term care insurance. He has served as a consultant to a number of employers concerning the design and financing of their employee benefit plans.
Prior to forming ARC and GRTCA, Mr. Trapnell was the senior actuary responsible for Medicare in the Social Security Administration. In this capacity, he was responsible for preparing long-range cost estimates for the Social Security programs, and for estimating the effect of proposed legislative changes to these programs.
Mr. Trapnell is a Fellow of the Society of Actuaries, a Member of the American Academy of Actuaries, and received his B.A. in Mathematics from the University of Virginia.
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Monica Brenner
Since she joined Actuarial Research Corporation, Monica Brenner has worked extensively for the Office of the Assistant Secretary for Planning and Evaluation (ASPE). Most recently, she expanded a spreadsheet model developed by E.C. King to split CMS national health expenditures (NHE) by institutional status and age group, using the 1987 NMES files, for the years 1995-2005. She has developed a computer model, still being refined, which analyzes the expected end balance of medical savings accounts (MSAs) across a 44-year career span (age 21 to 64). She has also been replicating and expanding upon the results of two papers which examine the impact of different individual and aggregate deductibles on the amount of risk retained and ceded by an employers of varying sizes under a stop-loss reinsurance plan. In addition, she developed and maintains a data base of Medicaid expenditures by state, maintenance assistance status, basis of eligibility, and service, using the HCFA- 2082 and HCFA-64 reports, for use in analysis of projected maintenance-of-effort payments for each state, to be used in health care reform proposals. She has also analyzed catastrophic claims for the years 1989-1991 by diagnosis category and age/gender groups.
Ms. Brenner holds a B.A. in Mathematics from the University of Virginia.
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Sally Burner
Sally Burner, ASA, MAAA, joined Actuarial Research Corporation in 2005. She is a technical expert in actuarial modeling with significant federal government work experience gathered from her years as an actuary with the Centers for Medicare and Medicaid Services (formerly the Health Care Financing Administration) and the Social Security Administration.
Ms. Burner is an Associate of the Society of Actuaries, a Member of the American Academy of Actuaries, and holds a BS in Mathematics from Wheeling College (now Wheeling Jesuit University).
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Cathi M. Callahan
Cathi Callahan, A.S.A., M.A.A.A., joined Actuarial Research Corporation in 1986. Work in the past several has been in the following areas: analysis of the privately insured population and the private health insurance market, analysis of uninsured and low income populations, and general analysis of health spending and use.
For the U. S. Department of Health and Human Services, Ms. Callahan has been providing assistance in estimating and examining subpopulations lacking health insurance, as well as modeling eligibility for coverage of children under state Medicaid programs and SCHIP. For the California Health Care Foundation, Ms. Callahan worked on an evaluation of affordable coverage options for the uninsured that included first dollar plans as well as those providing catastrophic coverage. For Kaiser Family Foundation she has provided actuarial assistance in evaluating potential plans under various tax reform scenarios.
Incremental health reform proposals for the Department of Labor, DHHS, and the Commonwealth Fund have included expansions of the individual insurance market, as well as assistance for displaced workers, through revisions to the tax code. Analyses of these proposals have included eligibility modeling, actuarial value calculations, and premium estimates, and have reflected adjustments for the participating population and selection. Ms. Callahan has assisted the Joint Committee on Taxation in developing models for estimating the effects of proposed changes in the Federal income tax treatment of expenditures on health insurance and health care products and services.
Ms. Callahan is an Associate of the Society of Actuaries, a Member of the American Academy of Actuaries, and holds a B.S. in Mathematics from The College of William and Mary in Virginia.
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Holen Chang
Holen Chang is an actuary with a background in mathematical statistics. She joined Actuarial Research Corporation in 1982. Because she is proficient in FORTRAN and C as well as SAS, SPSS and various spreadsheet applications, her experience of implementing actuarial models includes both statistically analyzing the circumstance and actually designing/programming it. She was involved in developing a medical management information system for the Department of the Navy in early 80's. Since then, she spent a few years modeling rate books for several private Long-Term Care plans and developing a "Demand Insurance Model" to analyze the impact of cost sharing on the utilization, which was granted by the Office of the Assistant Secretary for Planning and Evaluation. More recently, she reviewed the actuarial equivalence of Child Health Insurance Program for several states; she also used the info provided by National Health Interview Survey to investigate the effects on utilization due to managed care. Currently, she works extensively to estimate the subtotals of non-institutional population of year 2000 and their medical costs by age, sex, and insurance status for the Special Policy Analysis Module. In addition to this, she also closely follows the release of Medical Expenditure Panel Survey via the Internet, in order to update some estimated statistics of both utilization and cost of national health care.
Ms. Chang is a Member of the American Academy of Actuaries and an Associate of the Society of Actuaries. She received a M.S. in Applied Mathematics from National Tsing-Hua University in Taiwan, ROC before she came the United States. She also holds a M.A. and a M.Ph. in Statistics from Yale University.
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Rosa Gautier
Ms. Gautier re-joined Actuarial Research Corporation in 2005. She is an associate of the Society of Actuaries and holds an MSc in Actuarial Science from the University of Illinois.
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James S. Genuardi
James Genuardi, a senior analyst, has been with Actuarial Research Corporation since 1980. He is currently participating in a number of activities for the CMHCB (High Cost) demonstration project evaluation for CMS. He has constructed raw claims databases using data from the Program Integrity TAP files for California, Texas, Florida, Oregon, Washington, New York and Massachusetts. He has written programs in the C+ language and in SAS to produce final action claims from raw claims. Mr. Genuardi has developed completion factors by type of service to estimate IBNR claims based on netted claims from each state identified above. He has also written SAS programs to monitor the ongoing operations of care management organizations (CMOs) participating in the CMHCB demonstration. These programs analyze the health services utilization and costs of both the control group and the treatment group for each CMO. Mr. Genuardi also has written SAS programs based on the coding nets submitted by each CMO in the demonstration program. These coding nets are used to identify high cost Medicare beneficiaries, based on prior health care expenses and/or health care conditions, which are eligible for enrollment in each CMO during the demonstration.
Mr. Genuardi is also participating in a project designed to estimate national spending for mental health and substance abuse (MHSA) treatment services within the framework of the National Health Accounts (NHA). The objectives of the study are to produce a time series of national spending estimates consistent with the methodology used in the NHA to produce spending estimates for other types of health services, and to develop projection methods which can be used to estimate future spending for MHSA treatment services. His responsibilities for this project include conducting a literature review of prior studies related to the use and cost of MHSA treatment services, identifying relevant data sources andevaluating their usefulness in preparing estimates of national spending, and developing methods to estimate national spending for MHSA treatment services by type of service, type of provider, and source of payment.
In 1996, Mr. Genuardi completed a project to develop improved methods for paying HMOs and CMPs under Medicare risk contracts. Some of the methods analyzed included prospective experience rating, partial capitation, blended rates, and reinsurance. The major objective of the study was to provide HCFA with the required information for development of a new payment method for HMOs and CMPs with Medicare risk contracts.
Mr. Genuardi also participated in an evaluation of two innovative Medicaid programs in the state of Arizona - the Arizona Health Care Cost Containment System (AHCCCS) and the Arizona Long Term Care System (ALTCS). His responsibilities for this project included: estimating overall revenues and expenses for each program and comparing AHCCCS and ALTCS program expenses to the estimated expenses for a traditional Medicaid program in an effort to estimate program savings/losses.
Mr. Genuardi has a B.S. in Economics from the Pennsylvania State University and an M.A. in Economics from George Washington University.
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Susan Gressang
Susan Gressang is an administrator at Actuarial Research Corporation, where she is responsible for general office management including accounting, government reporting, payroll, purchasing, ensuring compliance with Federal and state reporting and labor law requirements, and providing benefit administration. She also provides assistance to the actuarial staff as needed in proposal preparation and secretarial support.
Before joining ARC, Ms. Gressang was a Financial Services Representative for the First Union Brokerage Corporation and a Customer Service Representative for First Union National Bank.
Ms. Gressang holds a B.A. from Vassar College.
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Albert Ketler
Albert Ketler joined Actuarial Research Corporation in 2005 and employs his knowledge of the SAS System and other platforms in various data processing tasks.
Additionally, Mr. Ketler is responsible for Actuarial Research Corporation's Web page maintenance
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Edward C. King
Edward King is a senior research analyst for Actuarial Research Corporation. Mr. King has extensive experience with analysis of Medicare and Medicaid program expenditures and regulations. He provides technical assistance to the Office of the Actuary, CMS in preparing actuarial cost estimates for legislative proposals and proposed regulations that change the scope of benefits, eligibility standards, access to services, or reimbursement methods of the Medicare and Medicaid programs. He has conducted desk reviews and actuarial audits of bids submitted for the Medicare Advantage and Prescription Drug Programs.
Mr. King helped develop a Medicaid Forecasting System, which analyzes and forecasts program expenditures, and a Medicaid Demographic Model, which projects Medicaid enrollment. He helped develop alternative financining for Medicaid programs in Arizona, Missouri, Vermont, and California. He has also helped develop a social insurance model for financing long-term care for the States of Hawaii and Vermont. He has also helped develop age distributions of the National Health Expenditure Accounts for CMS, and he has developed spending estimates for mental health and substance abuse services for SAMHSA. He assisted in developing spending estimates for long-term care services for CBO.
Mr. King has helped with the data analysis for setting premium rates for private long-term care insurance and for private managed care programs.
Mr. King holds an M.A. in Anthropology from Northwestern University.
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James W. Mays
James Mays, Vice President for Management of Actuarial Research Corporation, joined ARC as an actuarial systems analyst in 1979. He has been directing systems development under an actuarial services contract to the Assistant Secretary for Planning and Evaluation/Health, Department of Health and Human Services (DHHS) since 1985. His principal duties have been in designing and implementing computer models for analyzing the effects of changes in Federal health policy.
Recently, Mr. Mays has been concentrating on pricing and cost-incidence issues associated with incremental health care reform. Specific areas analyzed included Medicare coverage of prescription drugs, group coverage to individual coverage conversion cost effects, multiple employer welfare arrangement rule liberalization, and mental health parity provisions. Current areas of special concern are implementation issues surrounding the Medicare Prescription Drug Improvement and Modernization Act of 2003 (MMA), implications of alternative HIPAA standard code sets and cost impacts of expansions aimed at children’s coverage and transition populations (e.g., near-elderly populations before Medicare eligibility).
During the past two decades, Mr. Mays has worked on health financing reform issues with the World Bank, USAID, and the ILO for governments in 16 nations in South America, Eastern Europe, and the Middle East and North Africa. Mr. Mays holds a M.S. degree in Computer Science from the University of Virginia.
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David R. McKusick
David McKusick serves as a senior actuary on the staff of the Actuarial Research Corporation. He has extensive experience in actuarial analysis related to health financing. His areas of expertise include the Medicare program, the Medicaid program, private group health insurance, prepaid group practice plans and alternative health care delivery systems. Under contract to the Office of the Actuary at CMS, Mr. McKusick has prepared a variety of cost estimates for proposed changes to the Medicare and Medicaid programs involving changes in medical technology, reimbursement procedures, alternative modes of treatment and eligibility changes. For example, he developed the methodology used to estimate the amounts of third party liability that should be collectible as a result of the Medicare Second Payer program. He has also conducted an analysis of the impact of alternative definitions of Medicare standard filing units based on the Current Population Surveys, the BLS Employee Surveys and the Survey of Health Plans. In addition, Mr. McKusick conducted a review of the Adjusted Average Per Capita Cost, a technique used by Medicare to reimburse health maintenance organizations. This review is to lead to recommendations for more accurate rate setting methods for government sponsored enrollees.
Mr. McKusick is a Fellow of the Society of Actuaries, a Member of the American Academy of Actuaries and received his Ph.D., specializing in economic demography, from the Johns Hopkins School of Hygiene and Public Health.
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Kerry Moroz
Kerry Moroz joined ARC in June 2000. Ms. Moroz assists in revising and updating the ARC Social Security Policy Analysis Model. This model is written in Visual Basic for Applications (VBA), and predicts changes in actuarial balance and other trust fund operations that result from various proposed social security programs. It has been designed to rigorously adhere to the projections of the Office of the Actuary at the Social Security Administration. She has also used the model to explore and compare various policy reforms proposed by individuals at the Urban Institute.
Ms. Moroz also consults to the Tricare Management Activity (TMA) in the Department of Defense, which provides healthcare coverage for the United States military. She assists in negotiating contracts with individual HMOs, evaluating the costs to the government of proposed changes in healthcare coverage, and comparing the costs of specific TMA regions in the United States to those of the country as a whole. In addition to working with health coverage, Ms. Moroz works with Tricare Dental Programs as well, providing cost estimates for various changes in dental coverage.
Ms. Moroz was involved in the development of a model to calculate the premiums for an optional fee-for-service supplement to the Medicare program (The ARC Medicare Fee-For-Service Model). Data was collected from the Medicare Current Beneficiary Survey (MCBS) and analyzed to determine the effects of various benefit packages. She aided in developing a regression model that simulates the decision process faced by Medicare beneficiaries when determining whether or not to purchase supplemental policies. This simulation was integrated into the model to incorporate the effect of adverse selection and induced demand on premiums. This work was performed under a subcontract with RAND and the Center for Medicare and Medicaid Services.
Ms. Moroz is currently in the process of formatting the model to read and process medical expenditure information from the Medical Expenditure Panel Survey (MEPS) for the Assistant Secretary of Planning and Evaluation (ASPE).
Ms. Moroz is also currently involved in a survey data collection for CMS and the Office of Strategic Planning (OSP). Information collected will include enrollment data for high and low option plans, enrollment data for employment-connected plans, and basic comparisons between employment-connected and individual plans. The survey is intended to better explain how beneficiaries respond to various changes in Medicare+Choice offerings.
Ms. Moroz has a B.S. in Mathematics from the University of Maryland, Baltimore County.
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Bill Pierce
Bill Pierce joined ARC in 2006 and is currently a member of the technical staff supporting CMS Medicare projects. Bill’s experience in the computer industry spans over 25 years. He has held positions in the areas of systems programming, engineering, consulting and teaching. Prior to joining ARC, Bill was a Senior Systems/Data Analyst with Standard Technology Inc. supporting projects for Department of Defense Tricare/Military Health System. Prior to working for STI, he held numerous technical and engineering positions with IBM.
In addition to working for ARC, Bill is a part-time faculty member at Hood College in Frederick, Maryland where he is holds the rank of Assistant Professor of Computer Science. His research and teaching interests are in the areas of computer architecture and system design, digital electronics, microprocessors, computer systems performance, and computer operating systems.
Bill has a M.S. in Computer Science from Hood College and is a member of the Association for Computing Machines (ACM) and IEEE Computer Society.
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Laurie Pekala
Laurie Pekala joined Actuarial Research Corporation as an analyst in January 2007. She is currently working with the Centers of Medicare and Medicaid Services on Medicare demonstrations aimed at improving the quality of care for Medicare beneficiaries while generating Medicare cost savings and creating incentives for physicians to adopt and integrate information technology systems including the BIPA Disease Management Demonstration, the Medicare Care Management Performance Demonstration, and the Electronic Health Records Demonstration. Some of her responsibilities on these projects include processing and analyzing Medicare claims data, maintaining the MCMP database, and producing quarterly monitoring reports. Ms. Pekala previously analyzed health care data for the Economic Census while working at the U.S. Census Bureau (2002-2006) as a survey statistician.
Ms. Pekala holds a B.B.A. in Business Economics from Loyola College in Maryland.
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Elizabeth M. Peppe
Elizabeth Peppe is a senior analyst at Actuarial Research Corporation. Ms. Peppe has developed, managed, and implemented a variety of analyses relating to both public and private health insurance. Her work has included survey development and comparative analyses of Medicare supplement plans, Medicare and individual HMOs, HEDIS data, and long term care insurance and quality.
Most recently, Ms. Peppe has assisted with ARC’s actuarial desk reviews and audits of the Medicare MA/PD Bids for the Centers for Medicare and Medicaid Services (CMS). She has also researched issues such as FEHBP premiums and long-term interest rates for HHS’ Assistant Secretary for Planning and Evaluation (ASPE). She has co-authored papers for the Kaiser Family Foundation regarding emergency department user characteristics and dispute resolution between consumers and managed care health plans.
Ms. Peppe has a B.A. in Economics from the Johns Hopkins University.
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Michael Sandler
Michael Sandler joined ARC in September 2006 and he has worked primarily on the Medicare Care Management Performance(MCMP) demonstration and the BIPA Disease Management demonstration for the Center of Medicare and Medicaid Services, as well the Social Security Model for AARP. Mr. Sandler has used SAS software to organize and analyze Medicare data used to monitor and reconcile the BIPA Disease Management demonstration at various sites. He has also helped to compile and edit the reports for those sites. Mr. Sandler is contributing to the application process as well as the implementation of the MCMP demonstration. He has compiled application information, assigned beneficiaries, and determined their eligibility using Microsoft Access and SAS software. Additionally, Mr. Sandler is working on long term adjustments to the Social Security Model for AARP.
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Lynette Sgrignoli
Since joining ARC in 2007, Ms. Sgrignoli has worked predominately for the Assistant Secretary for Planning and Evaluation/Health (ASPE) at the Department of Health and Human Services (HHS). Most recently, she researched and prepared a summary of the current status of the Massachusetts Health Care Reform. She is currently using the National Health Expenditure Accounts (NHA) data published annually by the HHS to project health care spending in Massachusetts and to create a model demonstrating the likely impacts of the reform.
Previously, Ms. Sgrignoli studied the characteristics of the “eligible but uninsured” population of children in the United States and paid particular attention to published statistics regarding children eligible for Medicaid and the State Children’s Health Insurance Program (SCHIP). She examined the techniques and differences of various sources of data to support improved modeling of alternative reforms to SCHIP. Additionally, she analyzed the Statistics of Income (SOI) data published online by the Internal Revenue Service to estimate the number of income tax filers who would benefit from alternative subsidy proposals tied to tax deductions.
Ms. Sgrignoli also assisted in the actuarial audits of Medicare Advantage (MA) and Prescription Drug Plan (PD) sponsors and in reviewing the reasonableness of MA and PD bids submitted by the sponsors for the 2008 and 2009 contract periods for the Centers for Medicare and Medicaid Services.
Ms. Sgrignoli received a B.S. in Mathematics from Salisbury University.
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Todd Trapnell
As the ARC project coordinator for the Medicare Health Support pilot Mr. Trapnell specializes in project management, analysis, resource allocation, and customer communications. Mr. Trapnell also works as an actuarial analyst, develops cost proposals and leads ARC’s data and infrastructure security initiatives. In addition to previously working as an Analyst at ARC, Mr. Trapnell has worked as a Sr. Product Manager at MCI and Virtela Communications where he was responsible for the development, launch and ongoing profitability of a number of managed network security services.
Mr. Trapnell holds a B.A. in Mathematics and History from Bowdoin College and a MSc. in Scottish History from the University of Edinburgh.
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Dan Waldo
Daniel Waldo joined ARC in 2008 as a senior economist. He has extensive experience in analysis of health financing. His areas of expertise include the Medicare program and national health expenditures. Prior to coming to ARC, he spent 30 years at the Centers for Medicare and Medicaid Services, where he was involved in development of U.S. national health expenditures estimates, the Medicare Current Beneficiary Survey, and -- most recently – information about the Medicare Part D drug benefit.
His work at ARC includes health policy modeling and projections of health spending.
Mr. Waldo has a B.A. degree in economics from Oberlin College and a M.A. degree in economics from the University of Wisconsin.
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John C. Wilkin
John Wilkin, a senior actuary on the staff of ARC, is an expert in estimating the cost of public and private insurance programs and is nationally recognized for his work in the areas of long term care (LTC) insurance and internationally recognized for his work in social insurance. More recently, he has been concentrating on managed care. He has been a consultant to several insurance companies in the design, pricing and receiving of LTC policies. He has served several professional organizations concerned with the LTC utilization and advised the NAIC on LTC issues and reserving. He is currently the chairman of the American Academy of Actuaries' Committee on Social Insurance and is responsible for developing Standards of Practice for actuaries practicing in the field of social insurance. Mr. Wilkin has worked with the states of Hawaii and Vermont on designing and financing a social insurance program for covering long-term care. In addition, he has worked with several countries (Malaysia, Venezuela, the Ukraine, Belarus, Thailand, Croatia, Bulgaria, Uzbekistan, Macedonia, Russia, and the Philippines) on reform of their social insurance programs to put their financing on an actuarially sound basis. He advises the Federal Government on possible programs covering health care and LTC and federal efforts to promote and regulate long-term care insurance. He is currently advising the Department of Defense on the effectiveness of proposed managed care programs to reduce the cost of the TRICARE/CHAMPUS program. Prior to joining ARC, Mr. Wilkin was a Supervisory Actuary at the Office of the Actuary, Social Security Administration.
Mr. Wilkin is a Fellow of the Society of Actuaries, a Member of the American Academy of Actuaries and holds a B.A. in Mathematics from The John Hopkins University.
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Michele “Shelly” Windsor
Michele Windsor, CPA, Controller at ARC, has over eighteen years of government contracting experience. She is responsible for all aspects of accounting, including billings, accounts payable, payroll, time keeping, accounts receivable, financial reporting and contract tracking using DELTEK GCS Premier Accounting and Job Cost System. She maintains, administers, and ensures government compliance of employee benefits, including two retirement plans and various employee insurance plans. She performs most contract functions including the preparation of cost proposals and reporting financial status of contracts to program managers. Ms. Windsor establishes and monitors the indirect rate structure, ensures compliance with Federal Acquisition Regulations, communicates with government agencies such as DCAA, CMS, NIH, and DoD to coordinate audits and contractual matters, and creates and submits the required annual incurred cost submission. She prepares the yearly budget and monitors actual costs to budgeted costs. Ms. Windsor supervises and trains members of the administrative staff in office procedures. She also provides assistance to the actuarial staff as needed in technical proposal preparation.
Ms. Windsor holds a B.S. in Business Administration from Strayer College. She is a Certified Public Accountant in the State of Virginia and a member of the American Institute of Public Accountants (AICPA).
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C. William Wrightson
C. William Wrightson, Vice President of ARC, served as one of Principal Investigators for ARC's study of actuarial methods to improve payments to Medicare risk HMOs. He recently completed a project for CMS, "Designing Alternative Medicare Fee-for-Service Products," that developed benefit designs and premium rates for a number of alternative products that could be offered by the Medicare program.
In addition to a strong technical background, Mr. Wrightson has extensive experience in the fields of health care financial analysis, analysis of alternative delivery systems, premium rate-setting methods, and program evaluation. He has also conducted numerous projects with HMOs concerning rate-setting methods, financial planning, and analysis of health services utilization data. He has assisted in the organization of a number of new HMOs by developing the financial base for successful operations. In addition, he has provided assistance to established plans especially with respect to the setting of premium rates for specific situations and new benefits.
Mr. Wrightson has published in the areas of HMO utilization and costs, evaluation of health programs, Medicare, Medicaid, and health care financial analysis. His publications have appeared in Medical Care, Health Affairs, Journal of Applied Probability, Advances in Health Economics and Health Services Research, GHAA Journal, and Health Care Financing Review. He authored HMO Rate Setting and Financial Strategy (Health Administration Press, 1990). He recently completed the manuscript for Rate Setting, Risk Adjustment, and Financial Strategy for Managed Care Organizations (Health Administration Press, expected publication date July 2002).
Mr. Wrightson holds Ph.D. and M.S. degrees in Operations Research from the University of California, Berkeley and an M.P.H. degree in Health Administration and Planning from the University of California, Berkeley.
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Sarah B. Yi
Sarah Beavers Yi joined ARC in 2000 and has worked on a variety of actuarial projects.
For the Employee Benefits Security Administration (EBSA) at the Department of Labor (DOL), she is currently using National Compensation Survey (NCS) data to study dispersion of employer-sponsored health insurance average benefit rates and the degree benefit rates predict cost in order to improve the modeling of incremental health insurance reform initiatives. Other work for EBSA has included assisting with preparation of the Private Pension Plan Bulletins and creating burden estimates for changes to 5500 filing requirements.
Ms. Yi has extensive experience and knowledge related to Medicare Prescription Drug (PD) plans authorized by the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003. She reviewed the reasonableness of PD bids submitted by Medicare Advantage (MA) and Prescription Drug plan sponsors and assisted in the actuarial audits of bids submitted by MA and PD sponsors for the 2006-2008 contract periods. She previously illustrated variations in PD cost-sharing permitted under MMA and examined the effects of possible supplemental plans on reinsurance payments and beneficiary premiums. Ms. Yi studied PD actuarial equivalence and actuarial value issues related to the legislation. She also modeled the effects of moderate subsidies on participation rates in Medicare prescription drug proposals discussed in Congress before the passage of MMA.
Ms. Yi has worked on a variety of other projects. She estimated growth in premiums from the mental health parity requirement for beneficiaries in the Federal Employees Health Benefits Program (FEHBP). She also estimated the monthly costs of services carved out from the State Children’s Health Insurance Program (SCHIP) and Medicaid, researched Medicaid benefits to incorporate into estimates of the population with comprehensive insurance coverage, and estimated benefit costs for the prescription drug portion of Pre-Standardized Medigap plans. In addition, she has reviewed ARC’s Medicare Actuarial Rate Structure (MARS) model.
Ms. Yi received a B.A. in Economics from The College of William and Mary in Virginia.
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Erika Yoshino
Ms. Yoshino has worked on several Medicare projects since joining ARC in 2005 These include the Medicare Care Management Program (MCMP) Demonstration and the Electronic Health Records (EHR) Demonstration, both related to the development of health information technology to improve care in small physician offices. She has assisted in writing the design reports and waiver packages for these projects, and created databases used to track applications and select practices for participation in the demonstrations. She also provides support on Medicare claims processing, including netting of claims for use in baseline estimates and analysis of comparison groups for the demonstrations.
Ms. Yoshino has also been extensively involved in the Medicare Health Support (MHS) pilot program for CMS. Work has included establishing procedures for data processing, manipulation, and analysis, especially with regard to eligibility for program populations. She has assisted in selection of intervention and control groups for the program, and in the production of summary quarterly reports on program expenditures.
Smaller projects have included updating ARC’s IBNR completion factor model and assisting in bid reviews of Medicare Advantage and prescription drug plans.
Prior to joining ARC, Ms. Yoshino was a statistical analyst at the Colorado Department of Health Care Policy and Financing. Ms. Yoshino holds a BA in Economics from the University of Colorado at Boulder, and an MSc in Actuarial Science from Cass Business School, City University of London.
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Shelley Young
Ms. Young joined Actuarial Research Corporation in 2006. The majority of her time is spent supporting the Medicare Health Support (MHS) project. The Medicare Health Support program is a demonstration designed to help reduce health risks, improve quality of care, and provide savings among Medicare beneficiaries with chronic conditions.
Recently, Ms. Young has also been doing work for the Office of the Assistant Secretary for Planning and Evaluation (ASPE) researching Medicare Advantage enrollment trends and projecting payments under different scenarios. She also helps with the MCMP (Medicare Care Management Performance) demonstration and the Medicare PartD Bid Reviews and Audits.
Ms. Young holds a B.A. in Mathematics and a B.S. in Financial Economics from the University of Maryland – Baltimore County.
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