Douglas Rodrigues

Douglas has over a decade of specialized experience in the Medicare Advantage (MA) and pharmacy markets, supporting a diverse range of organizations, including health insurance carriers, provider groups, employer-sponsored health plans, and independent health benefit trusts. He works closely with Medicare Advantage Organizations and at-risk provider groups to calculate year-to-date risk score and accruals, evaluate historical coding patterns, forecast population-specific risk scores, and identify opportunities to improve coding accuracy by addressing both under- and over-coding. Additionally, Douglas has extensive knowledge of the Medicare Advantage and Part D bid process, which allows him to guide health plans through the programs’ evolving complexities and nuances.

In the pharmacy sector, Douglas supports health plans and employer-based benefit programs with PBM audits, market checks, request for proposal evaluations, and ongoing analytical support. He is also a key contributor to the prescription drug benefits in the Milliman Health Cost Guidelines, which informs a wide range of commercial and Medicare-related analyses.

Douglas plays an integral role in research initiatives that leverage the CMS Research Identifiable Files. His work in this area focuses on evaluating market level risk adjustment performance, analyzing provider network efficiency, and estimating cost-saving opportunities through emergency department avoidance strategies.