Susan Pantely
FSA, MAAA
Principal, Consulting Actuary
San Francisco, CA, US
Susan Pantely is a principal and consulting actuary with Milliman's Health Practice. She is located in San Francisco, California, and Pittsburgh, Pennsylvania, and joined the firm in 1988.
Experience
Susan provides actuarial and consulting services to a broad range of clients, including Blue Cross/Blue Shield plans, HMOs, commercial insurers, government agencies, and healthcare providers. Her work includes rate development, provider contract review, reserve certification, capitation development, Medicare risk feasibility studies, HMO start-ups, HMO due diligence, and development of risk sharing and reimbursement arrangements for physician groups, PHOs, ACOs, and other integrated delivery systems.
In addition, Susan has extensive experience with the valuation, financial analysis, and projection of healthcare services for several state public health insurance (Medicaid) programs.
Publications and Presentations
- "Social Determinants of Health," Co-Author. Contingencies Magazine (American Academy of Actuaries), June 2020.
- "Healthy Adult Opportunity: CMS Guidance Details New Medicaid Program Reform Options for All States," Co-Author. Milliman White Paper, February 2020.
- Telehealth – A Digital Communication Approach to Improving Health, Co‑Presenter. American Academy of Actuaries Capitol Hill Briefing, September 2019.
- "Patient-Centered Medical Home: Developing the Business Case from a Practice Perspective," Co-Author. Milliman White Paper submitted to National Committee for Quality Assurance (NCQA), June 2019.
- Utilizing Metrics to Identify High Risk Patients and Other Analytic Tools to Reduce Readmissions. Presentation for 2019 Reducing Hospital Readmissions Summit, June 2019.
- "Whose Patient Is It? Patient Attribution in ACOs." Milliman Healthcare Reform Briefing Paper, January 2011.
- Medicaid Program Redesign: The Long Term Care and Developmentally Disabled Programs (report for Wyoming Health Care Commission, September 2006, co-author).
Professional Designations
- Fellow, Society of Actuaries
- Member, American Academy of Actuaries
Education
- BS, Mathematics, University of Pittsburgh
Affiliations
- Member, American Academy of Actuaries’ Health Practice Council
- Former vice president, Board of Directors, Society of Actuaries
- Member, Society of Actuaries’ Education and Examination Committee
- Member, American Academy of Actuaries’ Health Care Quality Workgroup
- Member, American Academy of Actuaries’ Medicaid Workgroup
- Former chair, Society of Actuaries’ Health Section Council
Publications
Read their latest work
Article
Medicare's telehealth coverage expansion during the COVID-19 pandemic
20 March 2020 - by Susan Philip, Susan Pantely
In the wake of the COVID-19 pandemic, could telehealth have the potential to replace some in-person services and better triage care based on needs?
Article
Healthy Adult Opportunity
08 February 2020 - by Christine Mytelka, Susan Pantely, Catherine E Lewis, Katherine Wentworth, Nicholas Bauman
State program directors face many complex considerations as they evaluate the Healthy Adult Opportunity 1115 waiver option.
Article
Independent Evaluation of Trend Development Methodology
02 January 2018 - by Chankyu Lee, Susan Pantely
This report contains the results of Milliman’s review of CollectiveHealth Inc.’s methodology for analyzing the healthcare cost trend of its clients.
Article
Key MACRA timeframes
03 August 2016 - by Susan Pantely, Pamela M. Pelizzari
This paper covers the timeframes associated with the Medicare Access and CHIP Reauthorization Act of 2015 with a focus on the Merit-Based Incentive Payment System and the Advanced Alternative Payment Model.
Article
The proposed federal exchange auto-enrollment process: Implications for consumers and insurers
28 July 2014 - by Paul R. Houchens, Susan Pantely
The auto-enrollment process will affect premiums and may create financial barriers to 2015 coverage.
Article
Whose patient is it? Patient attribution in ACOs
19 January 2011 - by Susan Pantely
The methods used to assign healthcare providers to patients will be critical.
Article
An electronic prescription for healthcare efficiency
01 January 2009 - by Susan Pantely
In this article for HealthWatch magazine, Milliman consultant Susan Pantely discusses the potential effect that existing technology for e prescribing has to improve both the quality and efficient delivery of healthcare. Actuarial analysis can help identify doctors who are overprescribing