Emma Kramer

FSA, CERA, MAAA

Principal and Consulting Actuary

Brookfield, WI, US

Main +1 262 784 2250 | Office +1 262 796 3472

Emma Kramer is a principal and consulting actuary with the Milwaukee office of Milliman. She joined the firm in 2013.

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Experience

Emma assists clients with Medicare risk programs, including ACO REACH, Medicare Advantage, and the Medicare Shared Savings Program (MSSP).

Emma is a Chartered Enterprise Risk Analyst. She assists insurance companies with various risk assessments, including Own Risk and Solvency Assessments (ORSAs).

Prior to joining Milliman, Emma spent several years working for two large health insurance companies where she supported contract negotiations with health care providers, as well as pricing, reserving, and forecasting for commercial lines of business in several states.

Professional Designations

Fellow, Society of Actuaries
Chartered Enterprise Risk Analyst
Member, American Academy of Actuaries

Education

BA, Purdue University, West Lafayette, Indiana
MS, Mathematics, Roosevelt University, Chicago, Illinois

Publications

Read their latest work

Article

Key questions healthcare provider organizations should ask when evaluating LEAD

08 January 2026 - by Emma Kramer, Noah Champagne, Chris Smith

We identify several critical questions ACOs will need to ask about LEAD, a new healthcare model announced by the Centers for Medicare and Medicaid Services.

Article

ACO REACH PY2026 explained: What is changing and why it matters

17 June 2025 - by Tabish Shaikh, Chris Smith, Emma Kramer, Noah Champagne, Nathaniel Jacobson

We put the Center for Medicare and Medicaid Innovation's 2026 updates to the ACO REACH program into context.

Article

Evaluating the effect of risk score increases in MSSP on federal expenditures across MSSP and Medicare Advantage

28 February 2025 - by Emma Kramer, Caroline Li, Cory Gusland

We estimate how increases in Medicare Shared Savings Program raw risk scores will affect the overall federal expenditures for the program and Medicare Advantage.

Article

ACO Primary Care Flex Model: Five key takeaways for ACOs considering participation

18 July 2024 - by Sam Shellabarger, Emma Kramer

We offer tips for ACOs considering participation in the ACO Primary Care Flex model offered by the Centers for Medicare and Medicaid Services.

Article

Shadow bundles: A big opportunity for MSSP and REACH ACOs

13 February 2024 - by Maggie Alston, Noah Champagne, Daniel DiNinno, Emma Kramer, Christopher Murphy

New data for the Medicare Shared Savings Program and ACO REACH models provide opportunities for managing referrals, but ACOs should know the data’s limitations.

Article

Interactions between the CIF and the +/- 3% risk score floor and ceiling in ACO REACH

10 January 2024 - by Emma Kramer, Caroline Li

With the Centers for Medicare & Medicaid Services’ ACO REACH Coding Intensity Factor, accountable care organizations face potential financial headwinds for plan years 2023 and 2024.

Article

Recent changes to ACO REACH financial benchmark methodology to account for PY 2024 fee schedule changes

07 December 2023 - by Emma Kramer, Caroline Li, Amanda Snyder

As the CMS Innovation Center revises how the ACO REACH Rate Book handles performance-year fee schedules, we provide average impact estimates at a state level and background information regarding the change.

Article

Reactions and thoughts on PY2024 ACO REACH methodology changes

07 September 2023 - by Emma Kramer, Noah Champagne, Sam Shellabarger

We summarize in detail the Center for Medicare and Medicaid Innovation’s guidance on methodology changes to the ACO REACH model.

Article

The Retrospective Trend Adjustment in Direct Contracting and ACO REACH: A brief explanation

05 December 2022 - by Emma Kramer, David Byron

It is essential that Direct Contracting Entities adjust their performance projections according to the Retrospective Trend Adjustment going into 2023.

Article

Evaluating the financial cost of the asymmetry in the MSSP risk score growth cap

10 May 2022 - by Jessica Kildow, Cory Gusland, Emma Kramer, Caroline Li

Milliman evaluated the financial impact of three alternative financial benchmark adjustment methodologies that aim to mitigate the adverse consequence to ACOs.

Emma Kramer

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Experience

Read their latest work

Key questions healthcare provider organizations should ask when evaluating LEAD

ACO REACH PY2026 explained: What is changing and why it matters

Evaluating the effect of risk score increases in MSSP on federal expenditures across MSSP and Medicare Advantage

ACO Primary Care Flex Model: Five key takeaways for ACOs considering participation

Shadow bundles: A big opportunity for MSSP and REACH ACOs

Interactions between the CIF and the +/- 3% risk score floor and ceiling in ACO REACH

Recent changes to ACO REACH financial benchmark methodology to account for PY 2024 fee schedule changes

Reactions and thoughts on PY2024 ACO REACH methodology changes

The Retrospective Trend Adjustment in Direct Contracting and ACO REACH: A brief explanation

Evaluating the financial cost of the asymmetry in the MSSP risk score growth cap

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CHOOSE A LOCATION AND LANGUAGE

Emma Kramer

Read their latest work

Key questions healthcare provider organizations should ask when evaluating LEAD

ACO REACH PY2026 explained: What is changing and why it matters

Evaluating the effect of risk score increases in MSSP on federal expenditures across MSSP and Medicare Advantage

ACO Primary Care Flex Model: Five key takeaways for ACOs considering participation

Shadow bundles: A big opportunity for MSSP and REACH ACOs

Interactions between the CIF and the +/- 3% risk score floor and ceiling in ACO REACH

Recent changes to ACO REACH financial benchmark methodology to account for PY 2024 fee schedule changes

Reactions and thoughts on PY2024 ACO REACH methodology changes

The Retrospective Trend Adjustment in Direct Contracting and ACO REACH: A brief explanation

Evaluating the financial cost of the asymmetry in the MSSP risk score growth cap

CHOOSE A LOCATION AND LANGUAGE