Someone has to do the math.

Before a program launches, before a rate is filed, before a contract is signed, someone has to do the math.

Third Horizon’s in-house actuaries and health services researchers are the people who take the claims histories, the population data, the regulatory constraints, and the unknowns, and turn them into numbers a leader can defend. The work is technical. The purpose is plain: to give decision-makers the honest picture they need.

A disciplined fan of actuarial uncertainty ranges with one central decision path

Key Capabilities

Ten disciplines, one job: numbers that hold up under scrutiny.

Pricing & Risk

Rate development and pricing. Setting premiums, capitation rates, fee schedules, and reimbursement rates.
Claims and cost trend analysis. Analyzing historical claims, utilization, and medical cost trends to project future spending.
Risk adjustment and risk scoring. Evaluating member or patient acuity and how risk affects payment, performance, and profitability.
Reserving and liability estimation. Estimating incurred but not reported claims, future liabilities, and other financial obligations.
Value-based care and alternative payment model support. Modeling shared savings, downside risk, bundled payments, episodes of care, and capitation arrangements.

Analysis & Compliance

Contract modeling and negotiation support. Assessing payer-provider contract terms, reimbursement scenarios, and financial exposure.
Network and population analysis. Evaluating population health risk, utilization patterns, provider performance, and network adequacy or efficiency.
Forecasting and financial modeling. Building projections for membership, revenue, medical expense, and margin under different scenarios.
Regulatory and compliance support. Supporting rate filings, actuarial certifications, bid development, and other regulated financial analyses.
Program and product feasibility. Testing whether a new health plan product, benefit design, or risk-based entity is financially viable.

How Teams Put It To Work

Putting it to work

Actuarial reserve triangle exhibit with an inset validation chart comparing projected and actual development

Value-based payment designPricing the risk arrangement, setting benchmarks and trend, building risk-adjustment and attribution logic and modeling the savings and downside each party carries.

Contract-to-actual analysisQuantify what a health plan or provider should have been paid under negotiated contract terms against what the claims actually paid.

Risk-adjusted forecastingProject membership, revenue, and medical expense under multiple scenarios, adjusted for population acuity and utilization trend.

Rate filing supportBuild and document the actuarial certifications, exhibits, and methodology narratives that regulators require before a rate can be approved.

Ready to put these capabilities to work?

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Leadership

Bobby Schenck, FSA, FCA, MAAA

Actuarial Leadership

Managing Director for Actuarial Services

Health care actuary and analytics leader with 15 years of experience spanning Medicaid, Medicare Advantage, commercial insurance, and value-based payment design. Leads actuarial and reimbursement strategy initiatives supporting behavioral health and health care transformation efforts. Prior to joining Third Horizon, Bobby was a Consultant at The Terry Group.

Andy Wilson, PhD, MPH

Analytics Leadership

Managing Director for Analytics

Health care analytics and payment design expert with more than 13 years of experience in episode-based reimbursement, pricing strategy, and value-based care. Leads payment reform and transparency initiatives for Medicaid programs, payers, and health care organizations nationwide. Prior to joining Third Horizon, Andy was Senior Vice President at Signify Health.