Brian
Weible
Julia Lambert
Steve Zoldos George
K. Hawkins Jr. Alison
Pool Greg
Fann
Ross
Winkelman Mary Hegemann
D.
Dale Hyers Ron
Burkhart
|
Brian
Weible, President, Wakely Consulting Group |
|
Experience |
Prior
to joining Wakely Consulting Group, Brian was chief actuary
and underwriting manager for a Florida HMO offering
commercial and government (Medicare/Medicaid) plans as well
as piloting a 24-hour health/workers' compensation insurance
product. Prior positions include work as a consultant for a
large Florida-based health insurance and managed care
actuarial consulting firm and positions with a multi-state
indemnity carrier offing fully insured and self-funded
accident and health products.
Brian offers professional advice and
opinion to several periodicals including the New York Times
and local business journals regarding actuarial and related
insurance and benefit issues.
Brian began his actuarial career in 1991. |
Professional
Credentials |
•
Fellow, Society of Actuaries (F.S.A.)
• Member, American Academy of Actuaries (M.A.A.A.) |
Areas
of
Specialization
|
• Managed
care strategic planning, pricing and analysis (HMO, PPO, EPO, PHO)
• Risk sharing arrangements (capitations, withholds, joint
ventures, provider fee
• schedules)
• Point-of-Service plan development and HMO/Insurer
contract development
• Pro Forma and Business Plan review and certification
• Claim Reserve analysis
• Premium/Deficiency Reserve analysis
• Medicare Parts A/B and Part D bid development
• Medicaid rate development and projection
• SCHIP/Healthy Kids product development and prices
• Self-Funded employer funding/contribution rate
development
• Provider fee schedule analysis
• Rate manual development and review (health, dental,
prescription drug)
• Underwriting and Experience Rating of large groups or
business segments |
|
Publications |
• New York Times
• St. Petersburg Times
• Medicare Advantage News
• Health Watch, Society of Actuaries
• Healthleaders/Interstudy
• DWG Cost Management Report
• Various business journals |
|
Education |
•
B.S. Mathematics, University of Missouri |
|
Julia Lambert, Principal, Wakely Consulting Group |
|
Experience |
Julia Lambert joined Wakely Consulting Group as a Principal in April 2008. Prior to Wakely, Julia was a Managing Principal and Medicare Actuarial Practice Leader at Reden & Anders where she served in a consulting capacity for eight years. Prior positions include work as a consultant for Leif Associates, and student actuary positions at Great-West Healthcare and Physicians Mutual.
|
Professional
Credentials |
• Fellow, Society of Actuaries (F.S.A.)
• Member, American Academy of Actuaries (M.A.A.A.) |
Areas
of
Specialization
|
• Medical expense projection and budgeting, premium rate development and rate filings for start-up and established commercial managed care entities, including HMO, PPO, POS, High Deductible and other insurance company product lines
• Development, analysis and review of physician and hospital fee schedules, capitation, and other risk sharing arrangements
• Development of Medicare Advantage and Part D bids
• Periodic financial and trend reporting, including leading trend driver analysis
• Medicaid and SCHIP/Healthy Kids risk feasibility analysis and development of medical expense projections
• Medicaid rate review in several states and certification of Medicaid checklist
• Analysis and review of risk adjustment methods
• Review of unpaid claim liability, including premium deficiency analyses, and preparation of actuarial certifications
• Review of small group rating practices and compliance issues
|
|
Education |
• B.S. Secondary Education, University of Nebraska – Lincoln
• M.S. Applied Mathematics, University of Colorado – Boulder
|
| Steve
Zoldos, Principal |
|
Experience |
Steve
has experience in group life, medical, dental, disability
and other employee benefit programs, along with continuous
and current experience with both private and public sector
employers. He entered the actuarial profession in 1980 and
formed Wakely Consulting Group Inc. in 1999 with Brian
Weible. |
Professional
Credentials |
•
Fellow, Society of Actuaries
(F.S.A.)
• Member, American
Academy of Actuaries (M.A.A.A.)
• Chartered
Financial Analyst (C.F.A.) |
Areas
of
Specialization |
•
Health benefits
• Life insurance benefits
• Disability income benefits
• Dental benefits
• Funding techniques
• Provider capitations
• Managed care contracting
• Benefit design and pricing of:
|
•
Commercial & Medicaid Health Maintenance
• Organizations (HMO)
• Preferred Provider Organizations (PPO)
• Exclusive Provider Organizations (EPO)
• Point of Service Plans (POS) |
|
|
Education |
•
M.S. Actuarial Science, University of Wisconsin-Madison
• B.S. Mathematics and Statistics, Marquette University |
| George
K. Hawkins Jr., Senior Consulting Actuary |
|
Experience |
George
has experience in group life, medical, dental, disability,
and various governmental programs. He started his
career in 1969 with a mutual insurance company, was the
chief actuary for a large third-party administrator, and was
also with the predecessor firm to Wakely Consulting Group.
He joined Wakely Consulting Group in 2005. |
Professional
Credentials |
•
Fellow, Society of Actuaries (F.S.A.)
• Member, American Academy of Actuaries (M.A.A.A.) |
Areas
of
Specialization |
•
Health Benefits
• Life Insurance Benefits
• Experience Rating
• Experience
Studies
• Dental Benefits
• Funding Techniques |
|
Education |
•
M.S. Actuarial Science, Northeastern University,
Boston
•
B.A.
Mathematics
University
of
Virginia
|
| Alison
Pool, Senior Healthcare Specialist |
|
Experience |
Since
entering the actuarial profession in 1983, Alison was
employed with a Blue Cross/Blue Shield company, and the
nation's largest independent third party administrator (TPA)
of health insurance plans for small employers. Prior to
joining Wakely Consulting Group as a consulting actuary, she
was employed at a large Florida-based actuarial consulting
firm. |
Professional
Credentials |
•
Associate, Society of Actuaries (A.S.A.)
• Member, American Academy of Actuaries (M.A.A.A.) |
Areas
of
Specialization |
•
Third-party plan administration
• State rate filings and actuarial certifications
• Claim liability and rate adequacy analysis
• Effectiveness and pricing of managed care products |
|
Education |
•
M.S. studies, Statistics, University of South Florida
• B.S. Mathematics, Birmingham-Southern College |
| Gregory
G. Fann, Senior Consulting Actuary |
|
Current Responsibility |
Greg is a
Senior Consulting Actuary with Wakely Consulting Group. He
joined the firm in 2006 and has worked as a health actuary
for 13 years. |
|
Experience |
Prior to
joining Wakely Consulting Group in 2006, Greg served as
chief actuary of a provider owned HMO and in leadership
roles of several managed care organizations, specializing in
Individual, Small Group, and Medicare Supplement markets. |
Areas
of
Specialization |
• Managed Care
Rate Development
• Underwriting
• Product Development
• Claim Reserve analysis
• Premium Deficiency Reserve Analysis
• Forecasting
• Managed Care Contracting
• Cost Containment Strategy
• Pro Forma and Business Plan review and Certification
• Provider-Owned Managed Care Organizations
• Federal Employees Health Benefit Plan Pricing
• Medicare Supplement Regulatory Filings
• Medicare Advantage/Prescription Drug Plan Bid Process
|
|
Publications & Presentations |
Greg was
the Chairman of the Southeastern Actuaries Conference
Scholarship Committee in 2000 and has moderated the health
discussion at the semiannual meeting. He has been a key
contributor for many years on the Society of Actuaries
examination committees and is currently Vice Chairman of the
Group and Health Company/Sponsor Perspective Examination
Committee. Greg has been a contributing columnist to
HealthWatch and volunteered on the actuarial task force
analyzing the impact of sudden changes to the U.S. Health
Care System. |
Professional
Credentials |
•
Fellow, Society of Actuaries (F.S.A.)
• Member, American Academy of Actuaries (M.A.A.A.) |
|
Education |
•
M.A.S Actuarial Science, Georgia State University
• B.S. Mathematics, Furman University |
|
Ross A. Winkelman,
Managing Director (Denver Office) |
|
Current
Responsibility
|
Ross is the Managing Director of the Denver office of Wakely
Consulting Group. He joined the firm in 2007 and has worked
as a health actuary for over 13 years.
|
|
Experience |
Ross has experience in healthcare financial analysis,
valuation, pricing and product development. He has recently
been focused on the use of risk adjusters for various
applications. He
has worked on most types of health products including
individual, small group, large group, Medicare Supplement,
Medicare Advantage, Medicaid, vision, dental, LTC and
disability. Ross
led his former firm’s efforts to identify optimal rating and
underwriting methods for small groups at renewal, and is in
the midst of an important research project for the Society
of Actuaries (SOA) on risk adjusters.
He has been involved in the development of Health
Cost Guidelines for two countries outside of the
U.S.
Ross has experience managing large projects and
multi-disciplinary teams of individuals, including managing
the healthcare portion of a multi-billion dollar bid for the
TRICARE military healthcare system.
He has worked on triennial examinations of insurance
companies on behalf of state insurance departments and has
experience estimating liabilities in support of financial
statement audits and litigation cases.
Ross led Milliman’s efforts to audit health plans’
2004 ACRP filings on behalf of the Centers for Medicare and
Medicaid Services.
Ross has developed Medicare Advantage feasibility
studies and bids for dual eligible and other special needs
populations.
Ross has advised state insurance organizations, military
health services companies, PHOs, HMOs, PPOs, other managed
care organizations including Medicaid managed care companies
and has supported Medicaid litigation projects. He has
developed rating models for many health plans, including
developing the rating structures for the Chilean ISAPRE
system. Ross is the Associate Editor for the SOA Health
Section’s newsletter, vice-chair of the SOA’s Communications
and Publications sub-committee, and a former member of the
Society of Actuaries managed care exam committee.
Ross was also a contributing author for the book,
“True Group Long Term Care”.
|
|
Publications |
•
SOA Research Project, 2007 – A Comparative Analysis of
Claims Based Tools for Health Risk Assessment
• SOA Research Project, 2006 – Health Plan
Provider Network Risk
• SOA Health Section News, August 2005 – Optimal
Renewal Guidelines for Small Group Rating
•
SOA Health Section News, August 2005 – Coverage of Spring
SOA Meeting in New Orleans
|
|
Presentations |
• “SOA Risk Adjuster Research Project”,
SOA / DMAA Predictive Modeling Conference, 2006, Orlando, FL
•
“SOA Risk Adjuster Research Project”,
SOA / DMAA Webinar, 2006 (Webinar)
• “Health Network Risk”,
SOA Spring Meeting, 2006, Hollywood, FL
•
“Small Group Renewal Rating”, LOMA
Health Underwriting Study Group, 2005, New Orleans, LA
•
“Optimal Renewal Guidelines for Small
Group Rating”, Milliman Health Forum, 2005, Tucson, AZ
•
“Optimal Renewal Guidelines for Small
Group Rating”, Web Seminar, 2005, Denver, CO
•
“Chile Health Cost Guidelines”,
Milliman Health Forum, 2003, Phoenix, AZ
•
“Issues in Employer Health Insurance”,
SOA Spring Meeting, 2002, Colorado Springs, CO
•
“Health Insurance Valuation”, Mexican
Actuarial Association, 2001, Mexico City, Mexico
• “Prescription Drug
Rating”, Milliman Health Forum, 2001, Orlando, FL
|
|
Professional
Designations |
•
Fellow, Society of Actuaries
• Member, American
Academy of Actuaries |
|
Mary Hegemann
,
Senior Consulting Actuary
|
|
Experience
|
Mary joined the Denver office of Wakely Consulting Group as a Senior Consulting Actuary in November 2008. During the prior 12 years, she was a health actuary holding positions with Reden and Anders (now Ingenix Consulting), Leif Associates, and Great-West Life.
|
|
Professional Credentials
|
• Fellow, Society of Actuaries (F.S.A.)
• Member, American Academy of Actuaries (M.A.A.A.)
|
|
Areas of Specialization
|
• Medicaid and SCHIP rate development and actuarial certification of CMS checklist
• Review of Medicaid and SCHIP rate development performed on behalf of health plan associations
• Analysis and review of risk adjustment methods
• Medicare MA and Part D Bid actuarial certifications including feasibility studies and bid preparation for special needs plans serving chronically ill, institutionalized, and dual-eligible populations
• High-risk pool consulting including fund projections, carrier assessments, drafting Bills with state legislators, premium rates, plan designs, audits, feasibility studies, and setting reserves
• Year-end reserve actuarial opinions, small group certifications, and rate filings
• Provider contracting analyses and negotiations
• Evaluating the cost impact of proposed legislation
|
|
Education
|
BA, Actuarial Science and Mathematics, University of Nebraska-Lincoln
|
| D.
Dale Hyers, Managing Director (Louisville Office) |
| Experience |
Prior to joining Wakely Consulting Group, Dale was the
President and co-founder of Hyers & Levy an actuarial,
insurance management and health care management consulting
firm. His actuarial training and experience began in 1964 at
Ætna Life & Casualty Insurance Company in Hartford,
Connecticut. It continued at Integon Life Insurance
Corporation in Winston-Salem, North Carolina, and Providian
(formerly Capital Holding Corporation) in Louisville,
Kentucky. He left Capital Holding to start Hyers & Levy
in 1983.
Dale has written a chapter on pricing of health care
benefits that appears in a book published by the American
Hospital Association. This book is titled HOSPITAL-SPONSORED
HEALTH MAINTENANCE ORGANIZATIONS: Issues for Decision-Makers.
His chapter is titled "Understanding the Rate Making
Process." He is also the editor of a study Hospital
Cost Analysis by DRG to provide a "standard"
for measuring the effectiveness of hospital medical cost
management programs.
Dale is a past President of the Southeastern Actuaries
Conference. He has been a consulting actuary for the Kentucky
Department of Insurance, Georgia Department of Insurance,
Hawaii Insurance Division, Indiana Department of Insurance,
Maryland Insurance Administration, Michigan Insurance
Bureau, Vermont Department of Insurance, Tennessee
Department of Commerce & Insurance and the Pennsylvania
Department of Insurance.
He has also been the State HealthCare Chairman of
Kentucky
on
behalf of the Health Insurance Association of America. |
|
Professional
Credentials |
• Fellow, Society of
Actuaries (F.S.A.)
• Member, American Academy of Actuaries (M.A.A.A.)
• Member, American Society of Chartered Life Underwriters
(C.L.U.) |
|
Areas of
Specialization |
• Product Development
• Pricing
• Valuation
• Provider Capitations
• Managed Care Contracting
• Insurance Operations Management
• Expert Witness & Testimony
|
|
Education |
• M.A. Mathematics,
University of Kentucky
• B.S. Carson-Newman College |
| Ronald
D. Burkhart, Consultant (Louisville Office) |
|
Experience |
Prior to joining Wakely Consulting Group, Ron was a
Consultant with Hyers & Levy an actuarial, insurance
management and health care management consulting firm.
Ron’s actuarial and analytical training began in
1979 at National Life and Accident Company in
Nashville
,
Tennessee
, and continued at two Blue Cross/Blue Shield organizations,
and a hospital-based HMO insurer.
For Wakely, he has been a consulting actuary for the
Kentucky Department of Insurance, Hawaii Insurance Division,
Indiana Department of Insurance, Maryland Insurance
Administration, Vermont Department of Insurance, Tennessee
Department of Commerce & Insurance and the
Michigan Insurance Bureau.
Ron has many years of experience in observing, analyzing
and measuring health cost data and the effect of cost
management techniques on the cost of health care. He was the
primary analytical contributor to the study Hospital Cost
Analysis by DRG. This study was published by Hyers &
Levy to provide a "standard" for measuring the
effectiveness of hospital medical cost management programs.
|
|
Professional
Credentials |
• Associate, Society of
Actuaries (A.S.A.)
• Member, American Academy of Actuaries (M.A.A.A.) |
|
Areas of
Specialization |
• Product Development
• Pricing
• Valuation
• Provider Capitations
• Managed Care Contracting
• Expert Witness Support
|
|
Education |
• B.S. Mathematics, David
Lipscomb College |
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