www.McCarthyActuarial.com About Mac McCarthy Mac is the president of McCarthy Actuarial Consulting, combining the discipline of actuarial science with extensive experience and a reputation for integrity to help employers, health plans and researchers find innovative solutions to health and welfare issues. He has over 30 years of health and welfare actuarial experience, with over 20 years advising employers and plans on the development and financial management of innovative programs. His specialties include consumer driven healthcare, wellness and disease management programs, multi-option benefit programs, post-retirement medical and disability plans. Mac is on the board of directors for the Conference of Consulting Actuaries, co-chairs the Conference of Consulting Actuaries’ Healthcare Reform Community, and is leading a joint work group of the Society of Actuaries and the American Academy of Actuaries to evaluate certain aspects of national health reform legislation. Before founding McCarthy Actuarial Consulting, Mac was a principal and national resource at Mercer Health & Benefits. Before that, he held a variety of group actuarial positions at two regional insurance companies. Mac received a B.S. in Mathematics from the Illinois Institute of Technology. He is a Fellow of the Society of Actuaries, a Member of the American Academy of Actuaries, and a Fellow of the Conference of Consulting Actuaries. Medical Travel Today (MTT): Can you give our readers some background on your company? Mac McCarthy (MM): McCarthy Actuarial Consulting (MAC) combines the discipline of actuarial science, extensive consulting experience and a solid reputation of integrity to help employers, health plans and researchers develop innovative solutions to health and welfare benefit issues. MAC consultants are at the forefront of breaking benefits issues, particularly in the areas of healthcare reform, provider risk solutions, wellness best practices and health and wellness financial strategies. MTT: What strategies does your company employ to ensure employers, health plans and researchers are able to find the best solutions to health and welfare issues? MM: There are three attributes that are essential for a consultant to be successful in helping clients achieve their goals: technical skill, consulting experience and integrity. MAC combines these attributes to provide the highest quality actuarial services to a variety of market segments. Technical skill at MAC includes knowing when we are moving outside the realm of historical precedence, and having the ability to develop innovative solutions today for tomorrow’s problems. This is more critical now than ever because employers, health plans and the nation struggle with out-of-control health expenditures and the realization that traditional approaches will not provide a solution. MAC consultants are proven innovators, quick to identify new opportunities arising out of emerging technology, evolving healthcare delivery systems and data capabilities. Consulting experience teaches you to appreciate the uniqueness of every business situation, for example, consulting can be very useful if you are looking into HOW TO START A HVAC BUSINESS, what you need to do so, and how to start thinking about what you want from your business. MAC consultants ask probing questions and actively listen to the responses to understand the current situation, not just regarding the benefit program, but also the client’s core business. We work with clients to find the best possible solution to their benefit issues in a way that supports the business goals of the organization within a framework where the program can continue to improve and respond to changing circumstances. As for integrity, clients can be confident that their interests always come first. Our recommendations and advice are based on what’s best for the client and backed up by objective, reliable actuarial analysis using the best data available. We accept no commissions or payments of any kind except for consulting fees. We do not have a “product” to sell other than our good name and reputation. We have the courage of our convictions and the wisdom of experience to realize that it is in our best interest, as well as our clients’, to secure future business even at the cost of lower current revenue. MTT: Can you tell us a little more about your involvement with health and wellness? MM: I am currently in my fourth decade as a healthcare actuary. After 12 years working within the health insurance industry, I moved into a consulting role to advise employers and plans on the development and financial management of innovative programs. Over that time, I have developed a deep expertise in many aspects of health and wellness, including helping pioneer consumer-driven healthcare plans, wellness and disease management programs, multi-option benefit programs, post-retirement medical and disability plans. Almost five years ago, I founded McCarthy Actuarial Consulting to take my career to the next level. As healthcare reform legislation was being developed, I started the Healthcare Reform Community within the Conference of Consulting Actuaries (CCA) to promote sound actuarial considerations for healthcare reform at the national and state level, and provide an open forum for the exchange of ideas among actuaries concerned about reform efforts. I currently serve on the executive committee of the board of directors of the CCA, and also co-chair the Healthcare Reform Community. In the recent past, I have been active with various workgroups of the Society of Actuaries and the American Academy of Actuaries to evaluate various aspects of national health reform legislation and consumer-driven health plans. Current growth areas for us include consulting with healthcare providers, particularly in risk assessment for alternative payment models, as well as population health management programs, from employer as well as provider perspectives. MTT: What role does your company play in terms of helping health plan and ancillary health program administrator clients navigate through this time of rapid healthcare reform? MM: MAC assists employers and health plans arrive at workable solutions in light of economic and regulatory realities that make it increasingly difficult to adequately serve employees and plan members. Our consultants’ help clients understand new requirements, to realize what options are available to them, and evaluate, to the extent possible, how healthcare reform might evolve over the next several years. MTT: Does McCarthy Actuarial Consulting work with individuals, companies or healthcare professionals outside of the U.S.? If not, is this something that may happen in the future? MM: A number of our consultants, including myself, have provided consulting services outside the U.S. We have recently looked at a few such opportunities, but have concluded that they were not a good fit for us. Currently, we do not have any non-U.S. clients. MTT: As the medical tourism industry begins to advance, how do you think this will affect healthcare planning and pricing both in the U.S. and internationally? MM: Domestically, medical tourism has the potential to open up more options for individuals and plan sponsors, and perhaps inject additional market dynamics into an industry where few such forces exist today. Foreign-based providers must demonstrate both price AND quality advantages to be acceptable to American healthcare consumers. If they are successful in doing so, their influence will grow and domestic providers will be forced to respond in kind. The end result should be lower costs and higher quality. MTT: Do you have any additional advice? MM: A growing problem in the U.S., and internationally, is healthcare fraud and waste in the system. An analysis by Truven Health Analytics found that total waste in the U.S. healthcare system amounts to $600 billion, of which $125 – $175 billion is fraud and abuse. Much of this could be resolved through more sophisticated financial technology around the flow of claim dollars, similar to what has been in place in the financial markets for years. As challenging as it is to root out and fix the sources of this problem now, it will be even more difficult in a global environment. Medical tourism is one more reason to address this issue sooner rather than later.