WAKELY CONSULTING GROUP - Key Persons
Job Titles:
- Senior Consulting Actuary
Adam Rudin, FSA, MAAA, joined Wakely Consulting Group, LLC in April 2020 as a Senior Consulting Actuary. An actuary since 1996, his broad experience includes working directly for large health insurers, including responsibilities for individual, small group, and large employer health insurance markets. Throughout his career, he has been involved in all aspects of actuarial work, including pricing, reserving, forecasting, underwriting, risk adjustment, provider analysis, regulatory analysis, and has given testimony in state legislative hearings. He has worked with clients on both Affordable Care Act and Medicare risk adjustment and its implications to the client's business. Since joining Wakely, Adam has assisted clients with Medicare Advantage bids, developed rate filings for ACA individual plans, and worked with a device manufacturer on its value proposition to health plans. His latest focus has been on the implications of COVID-19 to Medicare Advantage and ACA marketplaces
Job Titles:
- Senior Consulting Actuary
Alison Pool, ASA, MAAA, has over 30 years of experience as a healthcare actuary. Her recent areas of focus have been on Medicare Advantage Organizations and self-funded employer health plans. Alison has been the lead actuary assisting clients in the management of MA-PD plans for more than 10 years and in multiple states. In addition, she works with self-funded employer plans to ensure successful management of their employee health benefits. Alison's varied experience includes emphasis in the preparation and certification of Medicare Advantage bids, self-funded employer group support (funding, liability, filing requirements, RFP data analysis), certification and rate development for MEWAs and METs, and support for participants in the Retiree Drug Subsidy. In addition, she has expertise in estimation of IBNP, rate adequacy, and estimation of future risks. Other projects include support for the evaluation of the Medicare VBID programs; co-authored papers on the new Hospice VBID opportunities and Point-of-Sale (POS) rebates; and authored papers reviewing international health programs.
Andrea Constantinos, FSA, MAAA joined Wakely Consulting Group, LLC as a Consulting Actuary in 2022. She has experience in financial reporting, reserving, forecasting, risk adjustment, trend analysis, and provider risk sharing arrangements.
Job Titles:
- Senior Consulting Actuary
Andy Large, FSA, MAAA, CERA, has been in the industry since 2007 and has been working as a consultant since 2012. Since his time at Wakely, he has signed ACA rate filings in the Individual and Small group markets, as well as certifying MAPD bids. He has also presented on ACA-related topics at several industry meetings, including the SOA Health Meeting and SOA Annual Meeting. He is currently the project lead on Wakely's Risk Insights for Medicare Advantage and Medicare National Report projects, which identify and quantify top drivers of profitability for a MAPD population at the member month level.
Job Titles:
- Senior Consulting Actuary
Robert Spence, ASA, MAAA, joined Wakely Consulting Group, LLC as a Senior Analyst in 2013. He has experience in pricing, financial reporting, benchmarking, risk score analytics, claim categorization, tool building, and SAS programming.
Brad Heywood, ASA, MAAA, works in the Denver office of Wakely Consulting Group, LLC. Since joining Wakely, he has been involved in a wide variety of areas within healthcare actuarial consulting. He has supported Medicaid Managed Care Organizations in financial reporting and performing various analyses such as rate review, trend analyses, lapse rate analyses and risk adjustment. He has become an ACO/DCE expert and has helped multiple ACOs/DCEs calculate their projected shared savings, apply for various CMMI programs and think through strategies under the various CMMI programs. He also supports Medicare Advantage plans with bid pricing, financial projections and strategic planning. In addition, he helped develop Wakely's Medicare Advantage Competitive Analysis Tool (WMACAT) that has been used by many clients to help analyze the competitive landscape in the Medicare Advantage world. He has worked in many areas within the ACA, such as standardized plan designing and implementation in various states, rate filing for individual clients, and rate review for various states.
Job Titles:
- Senior Consulting Actuary
Brad Jannsen, FSA, MAAA, works in the Minneapolis office of Wakely Consulting Group, LLC. Brad has worked on a number of actuarial functions including pricing, reserving, forecasting, risk adjustment, trend analysis, and reinsurance. He has certified Medicare Part C and D bids, ACA and Medicare Supplement rate filings and has been the lead actuary in Medicaid rate negotiations. Brad has worked across all levels within an organization and understands the importance of connecting and communicating with your intended audience.
Brian Machut, FSA, MAAA, started with Wakely in 2022 and works in the Minneapolis office. Brian has worked on a number of actuarial functions including trend analytics and forecasting, healthcare economics, and risk adjustment. He has also worked on the implementation and valuation of care management and affordability programs for large payers. He has extensive R programming experience, and is constantly looking for ways to intersect the methodologies of data science and actuarial science to produce insights for healthcare organizations.
Callyn Woodley, ASA, MAAA works in the Minneapolis office of Wakely Consulting Group, LLC. Callyn joined Wakely in 2020. Her work has included Medicaid rate review, risk adjustment, ACO modeling, and provider contracting analysis. Callyn has experience with Medicare Advantage pricing, and has helped support multiple clients in filing Medicare Advantage bids.
Casey Gardner, ASA, MAAA, joined the Minneapolis office of Wakely in 2019. His expertise is in Medicare Part D and actuarial applications of healthcare modeling. Casey has worked for both national and regional health plans on a variety of Medicare Part D related projects. Some of these projects include modeling Medicare Part D, understanding the implications of potential legislative changes on the Part D marketplace, providing formulary analysis, developing trend studies, and helping clients monitor and improve their pharmacy adherence to improve their Stars scores.
Chase Jackson, ASA, MAAA, joined Wakely Consulting Group, LLC as a Consulting Actuary in 2022. He has experience in reserving, forecasting, actuarial model building, SQL programming, and behavioral health claims analytics.
Job Titles:
- Senior Consulting Actuary
Chia Yi Chin, ASA, MAAA is a Consulting Actuary with Wakely. He has over two years of consulting experience as a benefits actuarial analyst prior to joining Wakely. Chia has worked closely with health insurance carriers nationwide through the Wakely National Risk Adjustment Reporting in analyzing risk adjustment impact for insurers in multiple states. Additionally, Chia worked with health plans to identify discrepancies on EDGE's reinsurance and risk adjustment calculation , identifying gaps in their risk adjustment results as well as analyzing financial drivers in the ACA market. Chia had also worked on projects providing analyses for the states of Oregon, Rhode Island, Maryland, Michigan and Illinois on the impact of essential health benefits. At a prior company, Chia was involved in postretirement benefits consulting and providing total benefits analyses and benchmarking for Fortune 1000 companies.
Christina Byrne works in the Tampa office of Wakely Consulting Group, LLC, an HMA Company. Christina joined Wakely in 2016. She specializes in supporting the submission of Medicare Advantage/Prescription Drug Plan Bids that project medical and pharmacy expenses for pricing and premium development. This includes analyzing detailed claims experience, performing trend analyses, and management of Medicare Plan Benefit Packages (PBPs). Her other experience lies in model development, Employer Group Waiver Plan pricing, evaluation of unpaid claim liabilities, and financial statement filings for managed care entities. Christina's recent work has been focused on developing and managing Wakely's suite of HEDIS products along with other internal quality initiatives.
Dagny Grillis, FSA, MAAA, CERA, PhD works in the Tampa office of Wakely Consulting Group, LLC. Since joining Wakely in 2017, Dagny's main focus has been on Medicare Repricing and ACA risk adjustment. Presently she manages Wakely's Medicare Repricing efforts and works on the Wakely National Risk Adjustment Reporting project, where she helps co-lead the team. Dagny also recently worked on modeling and data analytics for CMMI and Medicare Advantage VBID programs. Her other experiences include: pricing work for Medicare Advantage bids, pharmacy analysis, and support of Wakely tools and products, such as the Wakely ACA Pricing Model (WPM) and the Wakely ACA (WACA) data set. Dagny has a background in graduate research in partial differential equations and has published several papers in various mathematical journals. Before switching to actuarial work, she also taught undergraduate statistics and mathematics courses while finishing her doctorate in Mathematical Sciences.
Job Titles:
- Senior Consulting Actuary
Dani Cronick, FSA, MAAA works in the Denver office of Wakely Consulting Group, LLC. Prior to joining Wakely she worked for Humana on Medicare Advantage plan pricing. Since joining Wakely in 2017, she has supported providers within the Medicare Shared Savings Program, through risk sharing arrangements with payers, and in contract evaluation. She has also worked with payers within their Medicare Advantage bid pricing-including pricing of Employer Group Waiver plans-and both Individual and Small Group Commercial filings. Outside of pricing, Dani has supported clients in various strategic and competitive analysis efforts, including support for and development of the Wakely Medicare Advantage Competitive Analysis dashboard. She also has experience in the quality space working with Medicare Advantage Star Ratings, including evaluating the latest regulatory changes to Star Ratings and dissecting emerging trends in the Star Rating program.
Daniela Simpson, MS, MBA, joined Wakely Consulting Group in 2022 as Senior Consultant in the Tempe Office. She has over 20 years of healthcare experience, identifying data and analytic solutions and defining strategy to meet organizational goals. Daniela is a senior subject matter expert in data and analytics, specializing in end-to-end HEDIS data delivery solutions, from data operations and architecture through strategy design and adoption. She has strong hands-on experience with developing population-based studies and aligning quality improvement initiatives with NCQA, STARS, QRS and/or corporate value based strategies.
Prior to Wakely, Daniela worked for a large national healthcare payer in different leadership roles, operating at the intersection of business, analytics, and solution design. Most recently, she served as an Analytics Translator on the senior strategy team, working closely with the General Managers and Clinical Quality leaders to identify, prioritize, and execute the analytics solutions that would create highest value for the business. She integrated and streamlined the HEDIS data processes across all lines of business, coordinated and aligned all quality and risk adjustment data feeds, and let the transition to a new measure processing system, driving significant increase in star ratings and improved provider performance.
Darren Johnson, FSA, MAAA joined Wakely Consulting Group, LLC after graduating in summer 2016. He generally can be found anywhere insights need to be pulled from large datasets, and is the technical lead on the Wakely Pricing Model and WACA database.
Dave Neiman, FSA, MAAA is a Principal and Senior Consulting Actuary in the Denver office of Wakely Consulting Group, LLC. Dave joined the firm in 2012. His current client engagements include strategic financial management for Commercial, Medicaid and Medicare lines of business. He develops member level revenue, claim cost, quality metrics and risk adjustment analytics, reporting to support Medicaid rate negotiations, Medicare Advantage bid development strategy, and ongoing strategic financial management. Dave is the lead Medicare consultant for multiple plans, including bid certification, analytics, and forecast development. Applications of strategic financial management include the deployment of alternative payment models. He has served as a trusted advisor to health plans and provider systems in both the development and implementation of various options, including capitation and shared risk arrangements combining both financial and quality targets. Dave has supported the complete spectrum of the process from financial evaluation to contractual terms review to monthly operations. He has worked as a healthcare actuary since 2002.
Job Titles:
- Senior Consulting Actuary
David Walters, ASA, MAAA, joined Wakely's Tampa office in 2014. David's primary expertise is in pharmacy analytics and Medicare Advantage risk adjustment. He is Wakely's expert on Medicare Advantage Part D. David has researched the impacts of changes to the EDPS risk score models and authored papers on the impacts of the CMS transition to EDPS risk adjustment methodology. He developed the Wakely tool to process Medicare Advantage 837 files into linear data lines to enable 837 data to be loaded into standard relational databases. He has worked as a healthcare actuary since 2004.
Job Titles:
- Senior Consulting Actuary
Ed Mailander, FSA, MAAA, joined Wakely Consulting Group in May 2016. Prior to joining Wakely, he was Chief Actuary for over nine years at two different East Coast health insurers. He has over 30 years of health actuarial experience. Ed has managed actuarial teams for Commercial, Medicare Advantage and Medicaid lines of business including managing the pricing and forecasting for large block of Medicare Advantage business through the revenue reductions of the last 6 years. He oversaw the successful pricing of health exchange business. He also has managed informatics and underwriting teams. He has provided actuarial support to provider contracting departments and to a 450 physician staff model medical group. He has participated in several merger and acquisition projects being responsible for the actuarial and forecasting aspects of the projects.
He has extensive experience with Medicaid rate setting from the health plan perspective as chief actuary and from the consulting providing support to MCOs and state associations. He has worked with Medicaid programs in 10 states.
Job Titles:
- Senior Consulting Actuary
Emily Janke, FSA, MAAA works in the Atlanta office of Wakely Consulting Group, LLC. One of her recent projects is working with CMS as the data lead in designing and implementing a Value-Based Insurance Design (VBID) model to allow MA plans to offer a hospice benefit for the first time. She is the lead actuary and project manager responsible for strategy, design, and pricing of Fortune 500 group healthcare plans. Emily is an expert in claims data and works with large volumes of detailed claims data on a regular basis, including Medicare FFS data (CMS), Medicare Limited Data Set (LDS), and MarketScan. She also has considerable experience in network comparisons and repricings, including medical discount and total cost of care analysis. Emily has been with Wakely since 2018.
Job Titles:
- Vice President of Business Development
- Director, BCS
Scott King, Vice President of Business Development, has over 20 years of experience in sales and marketing roles within the health care consulting industry. Scott's prior experience includes 10 years business development with Milliman where he developed an agency network of over 40 brokers to engage in actuarial consulting services for third party clients. He has also been a District Manager for Old Northwest Agents and worked as a large case consultant for the Principal Financial Group. He has worked with a wide range of products, including individual major medical, small group medical, large group medical, self-funded plans, and non-medical group plans. He also has experience in assisting agencies in large case employee presentations and enrollments, and FSA implementation. He is nationally recognized as a speaker regarding employee benefits benchmarking topics such as plan designs, rates, contribution and cost control strategies, and Health Care Reform issues.