Kim Hiemenz is a principal and consulting actuary with the Milwaukee office of Milliman. She joined the firm in 2006 after working for two large insurance carriers.
Kim has extensive experience with managed care payment structures, including shared-risk and population-based payment arrangements. Further, Kim is very well versed in the Affordable Care Act (ACA) and Medicare Advantage (MA). She assists clients with ACA pricing and filings, and MA feasibility studies and bid development.
Kim provides financial and strategic risk management support to her clients. She assists clients with several facets of their business, including product development and pricing, experience analysis, valuation of reserves, financial reporting, and development of risk-sharing arrangements.
Kim’s clients include integrated delivery systems, hospitals, health plans, including provider-owned health plans, and Associations / Trusts.
Examples of Kim's engagements include:
Developing risk-based reimbursement models, including financial projections under various scenarios
Developing strategic analyses and payer contracting strategies
Developing pricing and filing structures for ACA products
Estimating Incurred But Not Reported (IBNR) claim liabilities
Developing customized utilization and cost benchmarks
Performing MA feasibility studies and bid development
Publications and Presentations
Co-Author, Providers, are you ready for employer-led accountable care? March 2019.
Co-Author, Will "Repeal and Replace" of the ACA cause pent-up demand to occur? March 2017.
Co-Author, Providers should do annual check-ups on Medicare Advantage risk-sharing contracts, January 2017.
The essential eight: Keys to successful ACO contracting, October 2015.
Professional Designations
Fellow, Society of Actuaries
Member, American Academy of Actuaries
Member, American College of Healthcare Executives
Member, Healthcare Financial Management Association
Member, National Association of Professional Women
Education
BS, Double Major in Mathematics and Risk Management / Financial Services, Illinois Wesleyan University
Employers are becoming increasingly involved in the movement toward value-based reimbursement, particularly employers that self-fund the healthcare needs of their employees.
23 March 2017 - by Kimberley Hiemenz, Michelle (Klein) Robb
This paper analyzes the impact of insureds utilizing more elective services in 2017 out of fear of losing or having reduced coverage with the repeal of the Patient Protection and Affordable Care Act (ACA).
12 January 2017 - by Kimberley Hiemenz, Simon Moody
It is imperative that providers review their Medicare Advantage shared-risk arrangements annually, particularly shared-risk arrangements set up to span multiple years.
22 December 2015 - by Kimberley Hiemenz, Simon Moody
The impact of risk adjustment can be substantial, and health plans operating under the Patient Protection and Affordable Care Act (ACA) need a thoughtful and innovative plan for managing risk scores.
