Five Questions With: Brian Mackintosh

Brian Mackintosh was appointed chief actuary at Blue Cross & Blue Shield of Rhode Island in early May. He returns to the company, where he worked previously in pricing and trend support, after spending time developing financial strategies for various facets of the health insurance industry. Mackintosh most recently served as chief actuary at AllWays Health Partners in Massachusetts. 

PBN: Please briefly explain what you will do as chief actuary at BCBSRI. 

MACKINTOSH: As chief actuary, I oversee the actuarial pricing and trend analysis teams. My major responsibilities include ensuring the company holds adequate reserves in order to pay expected claims, and developing premium rates that will cover the anticipated cost of care for our members.

Typically both of these functions involve analyzing past claim experience and extrapolating those costs to future periods. However, we’ve seen seismic changes in claim patterns this year due to the impact of COVID-19. As a result, we integrated pandemic models into our actuarial toolkit. This allows us to adjust future claim expectations in nearly real time as we closely monitor the emerging COVID-19 experience in the state.

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PBN: How does what you do directly affect customers? 

MACKINTOSH: The most direct impact is the actuarial role in setting premiums. We continually work to balance affordability with access to high-quality care and comprehensive benefits. Furthermore, along with our clinical management teams and provider partners, we analyze aggregate claims to identify opportunities to “bend the trend.” This can include, for example, identifying lower cost yet higher quality settings for clinically appropriate care. This helps mitigate premium costs.

PBN: In addition to a degree in math, you also have a degree in saxophone performance from the New England Conservatory of Music. Has being an accomplished musician contributed to your career in math and finance? 

MACKINTOSH: NEC prepared me for the business world in more ways than I ever expected! Two lessons stand out: First, while raw talent is great to have, only those who are willing to put in many thousands of hours of practice will reach the top of their craft. Similarly, nobody is born into this world with actuarial talent or natural data analytics skills; only those willing to put in the time and work to pass actuarial exams and gain real world experience will succeed.

Secondly, while solo artists can be wonderful, I find the most powerful music comes from ensemble playing. At BCBSRI, I’m privileged to lead a team of talented actuaries and analysts with diverse backgrounds. Their collaboration allows us to collectively dig deeper and broadly into the data, identifying more key drivers and opportunities than any individual could alone.

PBN: Is there anything specific you’re looking forward to working on as you settle in at BCBSRI? 

MACKINTOSH: I’m excited to take part in existing relationships with our providers, including Oak Street Health, to identify ways we can work together to bend the trend. But the No. 1 priority today, and likely for the next several months if not longer, is understanding how the COVID-19 pandemic will impact our total expected claims volume.

PBN: The COVID-19 health crisis has potentially changed the health care industry in some ways. Do you foresee the pandemic resulting in changes to the health insurance industry? 

MACKINTOSH: In recent years the health care industry has seen a trend toward greater collaboration between insurance carriers and providers in order to improve overall population health. In the past two months, this trend has accelerated in several ways, including:

Providers are leveraging telehealth options to continue to see patients, including through BCBSRI’s Doctors Online platform. This is one way we can ensure members have access to care in convenient settings, such as within their own home.

Providers, insurers and public health officials encouraging all patients to seek care when needed – the last thing we want is for our members to delay necessary care, which could lead to more-complex health problems down the road.

I’m hopeful that the pandemic will produce even more collaboration across the health care industry to drive innovative solutions that can help our members meet their individual health goals during this unprecedented time.

Elizabeth Graham is a PBN contributing writer.