Health Care Reform and Policy Consulting Services

As public health care reform and policies continue to shift and change, the Affordable Care Act (ACA) stands as a significant pivot point. Its implications, extending to public and private health insurance issuers, government agencies, employers, health care providers, pharmaceutical companies, and insurance consumers, have reshaped the health insurance industry. Amid this change, Lewis & Ellis’s (L&E) actuarial services offer expert insights and analytics, ensuring the most effective implementation of health benefit exchanges, rate review programs, and more.

Our approach to health policy consulting is deeply grounded in actuarial rigor, data-driven modeling, and a strategic mindset. We don’t just interpret regulations; our team of specialists translates them into actionable paths forward for clients across the spectrum of the health sector.

How Lewis & Ellis Can Help: Our Approach

Our team tracks and interprets regulation shifts and additions, ensuring we know the ins and outs of your industry requirements. Then, we use those expert insights to help you navigate compliance.

Here’s how we approach health policy consulting to ensure clients aren’t merely responsive but proactively positioned to thrive as public policy evolves:

Regulatory-Aware Modeling

We build and apply actuarial and economic models that reflect both current law and plausible reform scenarios, capturing enrollment shifts, premium impacts, and behavioral responses.

Tailored to Stakeholder Context

We recognize that state regulators, insurers, employers, and health providers all face different incentives and constraints. We customize our analyses accordingly.

Transparency and Communication

We help clients understand not just the “what” but the “why” behind results. That includes preparing user-friendly tools (e.g., checklists, disclosure forms, manual guides) and educating staff and decision makers.

Forward‐Looking Scenario Planning

Because health policy is in flux, we stress scenario-based stress testing of future reforms or legislative proposals.

Implementation Support

Beyond high-level advice, we assist in operationalizing policies: building rate review programs, exchange designs, data aggregation protocols, and public disclosures.

Cross‐Disciplinary Integration

We combine actuarial expertise with domain knowledge in health benefits, utilization, provider reimbursement, and compliance to deliver holistic insight that provides the full picture, taking out any guesswork.

Health Policy Consulting Services

Health Benefit Exchanges Design and Implementation

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. This enables states to predict and respond to enrollment and premium shifts triggered by new health care reforms.

Health Care Service Optimization

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 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.

State-Mandated Benefits and Proposed Legislation Assistance

Understanding and managing state-mandated benefits and the potential financial impact of proposed legislation is 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 health plan design.

When it comes to proposed legislation, our team offers comprehensive financial analyses. We carefully evaluate how proposed bills could potentially affect health care 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.

Comprehensive Review Programs

Health insurance rate transparency and fairness remain paramount, irrespective of policy type. At L&E, we’re 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.

We view rate reviews as more than a compliance exercise — it’s an opportunity for states and insurers to ensure fairness and transparency, benefiting all stakeholders in the health insurance industry.

Health Care Reform and Policy FAQs

What is health policy consulting?

Health policy consulting is when specialists help organizations navigate complex health laws, regulations, and market dynamics to better customer and patient care, manage costs, remain compliant, and improve future policies.

It differs from other types of management consulting due to its regulatory and legal sensitivity, high technical and actuarial content, longer time horizons, and public visibility, among other elements. That’s why it pays to partner with a trusted consulting firm that has your company’s back and understands your industry to a T.

What are Health Benefit Exchanges?

Health Benefit Exchanges are online platforms created by the ACA where small businesses, families, and individuals can find and compare health insurance plans, making coverage more affordable and accessible.

L&E provides data-driven analyses of populations to help predict trends and patterns and respond to enrollment and premium shifts.

What is health care policy development?

Health care policy development involves creating, implementing, and evaluating laws and regulations related to health care systems. These policies help establish guidelines that benefit patients, medical organizations, and systems.

For health care claim efficiency, L&E delves into provider reimbursement strategies, utilization changes due to chronic care programs, and conducts 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 our expertise, navigating the intricate world of health care reform and policy becomes a strategic journey toward a healthier future.

What are state-mandated benefits?

State-mandated benefits (also sometimes called guaranteed issue mandates, benefit mandates, or mandated health benefits) are coverage requirements imposed by state law or regulation that insurers must include in certain health insurance plans. While the specific mandates vary by state, common benefits include:

● Maternity and newborn care.
● Mental health and substance use disorder treatment.
● Rehabilitative and habilitative services.
● Preventive services/wellness screenings.
● Prescription drugs/pharmacy benefits.
● Pediatric services, including dental and vision.
● Reconstructive surgery (e.g., post-mastectomy).
● Emergency services/ambulance transport.
● Chronic disease management/home health care.
● Durable medical equipment.
● Prosthetics and orthotics.
● Hearing aids / cochlear implants.
● Infertility treatment/family planning services (in some states).
● Autism spectrum disorder treatment.
● Hearing, speech, and language therapy.
● Birth control/contraception/family planning.
● Coverage for certain conditions (e.g., diabetes, HIV/AIDS, cancer treatment).
● Telehealth and digital health services.
● Cost-sharing limitations or “essential coverage” definitions.

What are health insurance rate review programs?

Health insurance rate review programs are processes that review proposed health insurance premium increases to make sure they’re reasonable and backed by solid evidence. They’re often handled by state insurance departments, and insurers proposing significant increases must back it up by publicly explaining their reasons with easy-to-understand language.

At L&E, 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 health care landscape.

At L&E, we’re 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 health care policy changes.

Get Expert Support on Health Care Reform and Policy

Health policy consulting helps clients advance multiple dimensions of success, ensuring confidence in the road ahead. While keeping track of compliance requirements and following suit can be difficult and time-consuming, partnering with a trusted consultant like L&E can bring peace of mind.

When you work with our team of health care reform and policy specialists, you can enjoy:

● Risk mitigation: By quantifying impacts of regulatory changes before they occur (or as proposals surface), you can avoid adverse surprises, ensure compliance, and reduce financial downside.
● Strategic decision-making: Gain clarity about which policy options, product designs, or plan designs make sense under future regulatory regimes.
● Competitive advantage: By anticipating and adapting to reform, you can position your company ahead of peers through strategies like benefit design innovations, cost containment efforts, or favorable regulatory relationships.
● Operational efficiency: In designing rate review programs, disclosure processes, and data frameworks, you build more streamlined systems and avoid costly rework.

Whether you’re a state insurance regulator, health insurance carrier, employer, or pharmaceutical company hoping to adapt, cut costs, and better align with customer needs, L&E can be a valuable partner.

Contact us to learn more about our health policy consulting services.