Kyle McClone

Kyle has served many types of clients during his time with Milliman. He has assisted in performing actuarial work for Medicare Advantage organizations, state government agencies, and other healthcare clients. Kyle has extensive experience working for public health care program clients, including Florida, Mississippi, and South Carolina. His experience includes performing the following actuarial work:

• Developing Medicaid managed care capitation rates
• Analyzing managed care encounter data for completeness and accuracy, including ongoing communications with health plans to uncover and solve submission issues
• Developing custom risk weights and risk scoring algorithms to calculate plan-specific risk scores
• Analyzing the impact of changes in payment arrangements on Medicaid managed care programs, including the introduction of physician incentive programs
• Preparing analyses to respond to Medicaid MCO and CMS questions regarding capitation rates

Kyle has also spent significant time working for organizations that offer Medicare Advantage plans. This experience has provided him with insight into the perspectives of organizations that contract with government-run health care programs. His Medicare Advantage experience includes the following:

• Developing cost and revenue projections to assist clients in making strategic decisions
• Discussing strategic considerations of product and benefit offerings
• Developing bids and supporting documentation to submit to CMS
• Preparing responses to questions from CMS reviewers