Tom Kornfield

In his most recent role as a senior consultant at Avalere, he provided analytic support and strategic advice for clients on a wide range of Medicare policy issues. Before joining Avalere, he was Vice President of Medicare Policy at America’s Health Insurance Plans (AHIP), where he led risk adjustment policy discussions with plan members and external stakeholders. He spent 10 years at the Centers for Medicare and Medicaid Services (CMS) in a variety of roles tied to health plan payment and risk adjustment. In addition, during his tenure at CMS he originated the idea to allow five-star Medicare health plans to market and enroll year-round.

He is a leading expert on Medicare risk adjustment and payment policy. He has worked extensively with the risk adjustment model, served on expert panels, presented on risk adjustment policy in webinars and conferences, developed impacts of changes to the model, and conducted training on both risk adjustment and Medicare Advantage payment for industry. He led the development of the 2014 and 2015 annual Medicare Advantage and Prescription Drug Plan annual payment rate announcement. For these announcements, he coordinated efforts among several staff members and other components in CMS, developed bottom line impact analyses of the payment changes in the rate notice, and contributed technical sections on the payment methodologies for Medicare Advantage associated with the Affordable Care Act.

Tom holds an MPP from the University of Michigan’s School of Public Policy. His undergraduate degree is from Hamilton College