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Blaine has extensive ACA commercial pricing experience and has worked with multiple health plans on both pricing and reviewing rates. He has been extensively involved with multiple Consumer Oriented and Operated Plans with the pricing and filing for individual and small group Exchange products. He provides other actuarial support such as monitoring emerging plan experience, reserving, and modeling the impact of the ACA’s premium stabilization programs, most significantly, the federal risk adjustment program.
Blaine has also assisted in modeling the potential savings impact from implementing various healthcare quality and delivery improvement programs. He also models the impact of effectively integrating medical and behavioral healthcare services.
Blaine has significant experience assisting carriers with their large group pricing and filing needs, along with underwriter support and modeling for group quotes.
Blaine also has experience assisting managed care organizations with the reviewing of their annual capitation rate setting process with state Medicaid agencies. More recently, Blaine has been helping accountable care organizations and other provider groups review their networks and analyze performance in order to help maximize the potential success of risk-sharing agreements and programs.