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. Rates that hold up. Forecasts that stand up. Contracts priced for the risk they actually carry. The work is technical. The purpose is plain: to give decision-makers the honest picture they need.
Key Capabilities
Setting premiums, capitation rates, fee schedules, or reimbursement rates.
Analyzing historical claims, utilization, and medical cost trends to project future spending.
Evaluating member or patient acuity and how risk affects payment, performance, and profitability.
Estimating incurred but not reported claims, future liabilities, and other financial obligations.
Modeling shared savings, downside risk, bundled payments, episodes of care, and capitation arrangements.
Assessing payer-provider contract terms, reimbursement scenarios, and financial exposure.
Evaluating population health risk, utilization patterns, provider performance, and network adequacy or efficiency.
Building projections for membership, revenue, medical expense, and margin under different scenarios.
Supporting rate filings, actuarial certifications, bid development, and other regulated financial analyses.
Testing whether a new health plan product, benefit design, or risk-based entity is financially viable.