Lewis & Ellis, LLC

Health Care Reform & Policy

Strategizing a Healthier Future

In the evolving landscape of health care reform and policy, the Affordable Care Act (ACA) stands as a significant pivot point. Its implications, extending to public and private health insurance issuers, employers, health care providers, and insurance consumers, have reshaped the health insurance industry. Amid this change, L&E's actuarial services offer strategic insights, ensuring the most effective implementation of health benefit exchanges, rate review programs, and more.

Ensuring Fair Rates with Comprehensive Review Programs

Health insurance rate transparency and fairness remain paramount, irrespective of policy type. At L&E, we are committed to facilitating the development and implementation of thorough and effective rate review programs. We have helped states across the nation develop robust rate review programs that apply to all types of health insurance policies, ensuring they meet the rigorous standards of both state and federal regulations.

Our comprehensive services extend to proposing and implementing strategies for the public disclosure of rate filings, refining federal and state legislation for a comprehensive, fair, and transparent review process, and suggesting innovative methods for automating review programs. In addition, we aid in the development of review manuals, checklists, and public disclosure forms that enhance the review process's efficiency and clarity.

Furthermore, we offer strategic recommendations regarding data collection and aggregation for future reporting in the diverse health insurance market. This proactive approach not only assists in maintaining a rate review program but also equips our clients with the necessary tools to anticipate and respond to future trends and changes in the healthcare landscape.

At L&E, we view rate reviews as more than a compliance exercise – it is an opportunity for states and insurers to ensure fairness and transparency, benefiting all stakeholders in the health insurance industry.

Designing & Implementing Health Benefit Exchanges

At the heart of health care reform is the design and effective implementation of Health Benefit Exchanges. L&E's robust technical prowess and comprehensive health care industry knowledge provide independent, data-driven analyses that help states efficiently manage their populations. Our engagement with multiple state insurance and Medicaid departments has resulted in the creation of tailored actuarial and economic models, enabling states to predict and respond to enrollment and premium shifts resulting from new healthcare reforms.

Optimizing Health Care Services

L&E collaborates with state agencies, national associations, and employers to assess the impact of federal reform implementation. We develop and analyze coverage and cost impacts of alternative health care reform initiatives. Our services span across policy development, claim efficiency, and cost impact analyses.

In health care policy development, we craft and scrutinize health care reform alternatives, adapt reform initiatives based on stakeholder feedback and budget constraints, and assess regulatory policies. We help design and evaluate insurance plans, aiming to optimize health care coverage and reduce costs.

For health care claim efficiency, we delve into provider reimbursement strategies, utilization changes due to chronic care programs, and conduct disease management analyses.

We also estimate the coverage and cost impacts of reform alternatives, determining increased access to health care, consumer premium rates, stakeholder investment costs, and the impacts of benefit design changes and eligibility rules.

With L&E's expertise, navigating the intricate world of health care reform and policy becomes a strategic journey towards a healthier future.

Navigating State Mandated Benefits and Proposed Legislation

In an ever-evolving healthcare landscape, understanding and managing state-mandated benefits and the potential financial impact of proposed legislation becomes increasingly critical. L&E is equipped with the knowledge and expertise to help you navigate these complex areas.

For State Mandated Benefits, we conduct in-depth analyses to comprehend the full spectrum of costs, benefits, and potential impacts associated with specific mandated coverages. Our experts meticulously analyze coverage mandates within the context of your specific situation, ensuring you understand how these requirements could affect the cost of care, the premium rates, and overall plan design.

When it comes to proposed legislation, our team offers comprehensive financial analyses. We carefully evaluate how proposed bills could potentially affect healthcare costs, premium rates, and market dynamics. Through predictive modeling and scenario analyses, we provide insight into the future financial implications of legislation, offering clarity for decision-making.

At L&E, we are committed to providing you with the actionable insights and strategic guidance needed to effectively respond to state mandated benefits and proposed legislation, helping you adapt and thrive amid healthcare policy changes.


Consultants to Contact


“We are extremely pleased with their work to date and would highly recommend their professional actuarial services for your needs.”

-- Oklahoma Department of Insurance