HEALTHCARE CONSULTING

PACE actuarial and strategic consulting services

Medicare Part D bid development, PBM consulting, and other actuarial analytics for organizations offering a Program of All-Inclusive Care for the Elderly.

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PACE actuarial and strategic consulting

Download our brochure

Overview

What is the Program of All-Inclusive Care for the Elderly (PACE)?

To support the aging U.S. population, an increasing number of organizations, primarily healthcare providers, are creating a Program of All-Inclusive Care for the Elderly (PACE).

PACE organizations provide comprehensive, community-based care to individuals ages 55 and older who require nursing-home-level services. These individuals are cared for by an integrated, interdisciplinary team, often through adult day health centers. Many individuals served by PACE are eligible for both Medicare and Medicaid.

Why every PACE program needs an actuary

An actuary is required for a PACE program’s success. Actuaries help ensure financial viability, adequate risk management, and legislative / regulatory compliance by offering guidance through an actuarial lens.

PACE actuaries assist with capitation rate setting, consulting on pharmacy benefit managers (PBMs), and preparation of Medicare Part D bids—the expected costs of providing covered prescription drugs. Part D bids must be submitted every year to the Centers for Medicare and Medicaid Services (CMS) and certified by a qualified actuary.

WHY MILLIMAN

Choose the leading PACE actuary in the country

OUR SERVICES

Tailored actuarial services for new and established PACE programs

Milliman provides comprehensive actuarial consulting for Programs of All-Inclusive Care for the Elderly. Select the links below to learn about some of our services.

Benchmarking
Fraud, waste, and abuse monitoring
Medicaid rate reviews
Medicare Part D bids and reconciliation estimates
Medicare payment audits
Pharmacy, PBM, and drug cost management

Benchmarking

Milliman provides drug cost and other bid-related benchmarking to help PACE organizations optimize financial performance while navigating Medicare Part D regulations.

INSIGHT

Read our thought leadership on PACE program developments

WHITE PAPER

Updated CMS guidance on Medicaid rate setting for PACE organizations: Key changes and implications

With a significant update to the PACE Medicaid Capitation Rate Setting Guide, state agencies need to assess the change and identify necessary modifications.

Read the white paper

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