Matt Kridgen

Medicare Advantage and D-SNPs

Matt has spent his entire career working with Medicare Advantage plans to prepare and certify annual CMS Medicare Advantage and Part D bid submissions. Beyond bid preparation, Matt provides analytical and actuarial support for all elements of Medicare Advantage plan operation, including medical and Rx cost projections and benchmarking, risk score analytics and operations, provider contracting and capitation rate negotiations, Star Ratings analysis and improvement, and PBM contracting support. Matt has particular expertise in support for Dual Eligible Special Needs Plans (D-SNPs).

Medicaid Consulting

Matt has spent more than a decade working in the Medicaid space, supporting both managed care plans and state Medicaid agencies. He works with his health plan clients on a vast array of financial and actuarial analyses, including provider capitation rate setting, state capitation rate evaluation, reserving and financial reporting, and annual budgeting. He has worked with state agencies to develop managed care capitation rates and project the financial impact of program changes. His work on D-SNPs and coverage for dually eligible beneficiaries extends to the Medicaid space.

Financial Reporting

Matt works with clients across the spectrum of healthcare delivery on financial reporting, including annual statements of actuarial opinion for state regulatory filings. He estimates accruals for incurred but not paid/reported claims, Medicare Advantage risk scores, and settlements for Part D pass-throughs and risk corridors, among other uncertainties.

Managed Care Research

Matt is a leading member of the team that develops the Milliman Health Cost Guidelines, with a particular focus on quantifying the impact of managed care in the commercial market.