Cost reduction and performance improvement: Actuarial and underwriting

The challenge

Operational effectiveness. Financial performance. Actuarial and underwriting activities contribute significantly. Payers can drive bottom-line improvements and increase market share by improving the consistency, sophistication and accuracy of actuarial and underwriting processes, policies and practices. Mandatory reporting requirements, consumerism and new interventions, such as preventive care and disease management, complicate the process of developing a rating formula that accurately assesses the impact of this broadening array of benefit options and risk factors. Payers need to examine their underwriting guidelines to ensure that they are applied consistently. They also need to track underwriting results and decisions to assess whether they reflect the right mix of risk factors.

Competition and margin pressures demand that actuarial and underwriting activities show improvement in organizational integration, data quality, pricing accuracy and consistency, product development, risk assessment and management reporting. To accomplish these goals, payers are evaluating their actuarial and underwriting functions compared with industry standards and leading practices. In many cases, government regulations require independent, third-party verification of compliance with these standards and practices. Assessing current processes, tools and controls benchmarked against industry best practices provides the foundation for a gap analysis and strategic plan to migrate to optimized processes and practices. Payers who can accurately rate and administer highly customized plans with a wide variety of benefit options will have a competitive advantage over payers offering less flexible standard products.

How we can help you

You need to drive bottom-line improvements and increase market share through accurate actuarial and underwriting processes. We can help you assess your operational effectiveness in many key areas. The financial improvement resulting from our review will depend on the effectiveness of your actuarial and underwriting functions today. Past reviews have had a documented earnings impact of 2 to 5 percent of revenue.

You need to evaluate your actuarial and underwriting functions compared with industry standards and leading practices. Our experience advising the federal government gives us expertise in helping clients prospectively rate Medicare products such as Medicare Advantage and Part D. We can focus narrowly on your actuarial and underwriting functions or broaden our scope to include end-to-end processes including sales to close, product development or financial management.

Common services include:

• Integrated actuarial and underwriting functions
• Risk assessment and risk management
• Metrics and reporting
• Pricing and rating methodology
• Book-of-business experience monitoring and new business selection
• Regulatory compliance
• Budgeting and forecasting

Based on these assessments, we collaborate with you to implement process improvements that include:

• Identifying gaps and feasibility for change
• Developing business cases and implementation plans
• Migrating processes and practices to the desired future state
• Updating pricing factors and methodologies
• Monitoring progress and financial impact