Kristy Piccinini, Ph.D.

Kristy Piccinini, Ph.D., has more than 20 years of experience in public policy and health economics research, advising public and private sector clients in the healthcare and life sciences industries. Dr. Piccinini specializes in modeling public and private health insurance enrollment, utilization and premiums; measuring access to care and healthcare provider supply; and evaluating drivers of utilization and outcomes in innovative care delivery models. Her expertise also includes assessing prescription drug utilization and pricing data, as well as programs serving vulnerable populations.

With a strong background in healthcare datasets, Dr. Piccinini applies advanced simulation and econometric modeling supported by qualitative research to conduct detailed policy impact analyses. She helps clients understand how federal and state policies affect healthcare costs and quality, and uses sophisticated models and data sources to project the impacts of legislative and regulatory changes on insurance enrollment, care utilization and spending. Her work helps address critical regulatory, policy and strategic challenges across the healthcare sector. She also evaluates financial and delivery system changes to assess return on investment and the effects on population health.

Dr. Piccinini has collaborated with federal and state agencies to implement and support health insurance exchanges under the Affordable Care Act, providing ongoing operational and analytic expertise. Additionally, she has led monitoring and evaluation projects for innovative care models developed by the Center for Medicare and Medicaid Innovation, including models dedicated to incorporating value-based care for Medicare Advantage enrollees and for disease conditions, such as preventing progression to diabetes and enhancing options for medication therapy management. Her expertise extends to health plan compliance, particularly in quality measures for appropriate medication use, formulary assessment and network adequacy.

Dr. Piccinini has led teams in developing analytic methods for identifying potential fraud, waste and abuse in administrative healthcare data. She has supported congressional agencies in evaluating policy options for improving payment structures in Medicare and Medicaid, helping shape strategies for more efficient and effective healthcare programs. She previously conducted this type of analysis as an analyst at the Congressional Budget Office (“CBO”) and as a contractor for the Centers for Medicare & Medicaid Services (“CMS”), where her work informed both policy and operational decisions.