Health insurance exchange services


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The Patient Protection and Affordable Care Act (ACA) calls for states to have fully operational health insurance exchanges by 2014, with key milestones that must be in place earlier.

Milliman is uniquely positioned to help states successfully implement an exchange or multiple exchanges.

Known for our technical acuity and comprehensive knowledge of the healthcare industry, Milliman offers independent analysis to help states cost-effectively manage their populations without compromising quality of care.

As the largest healthcare actuarial consulting firm, Milliman has assisted a wide variety of clients in making difficult, data-driven decisions. To assist clients in preparation for the health reform changes being phased in between now and 2014, Milliman has developed the Healthcare Reform Financial Analysis Model, the most sophisticated tool in the market for analyzing the implications of healthcare reform. This combination of top-tier consulting and a robust analytic tool are unmatched by any other consulting firm.

As a world leader in risk adjustment, Milliman has consulted with governments across the US and Europe and in other developed healthcare economies. With risk adjustment becoming a more profound aspect of the American healthcare system under the ACA, requiring states to get a handle sooner rather than later on their uninsured and underinsured populations, this expertise can be critically important to helping anticipate the issues that states must address and resolve in implementing exchanges.

Milliman offers sophisticated risk adjustment software to state insurance exchanges free of charge. Milliman Advanced Risk Adjusters (MARA) provides a highly predictive, completely free set of risk adjustment models that can help states identify where risk is most likely to emerge, allow them to benchmark improvements, and identify people who may benefit from assistance in effectively managing their health.

Scenario simulation tool

To help states understand the enrollment and premium shifts that may occur due to implementation of exchanges and other changes to the health insurance marketplace, we have developed a sophisticated scenario simulation tool: the Milliman Healthcare Reform Financing Model.

This model can answer reform questions with a high degree of detail using a number of different variables, including population by income, current health status, insurance (if any), and approximate costs and cost variation between markets.

Information technology expertise

Milliman technology consultants have a wide range of information technology and operations expertise, focused in three primary areas:

  • The development of custom applications and the seamless system integration of multiple vendor solutions.
  • The implementation and enhancement of decision support, business intelligence, and analytical capabilities.
  • The assessment of information technology infrastructures as they relate to desired business functionality, as well as the design, planning, acquisition, development, and implementation of new and improved infrastructure that includes careful management of resources and key stakeholders.

This expertise enables Milliman to evaluate a state's existing technology infrastructure and related business processes, and to identify the specific changes required for implementing an exchange or multiple exchanges.

Business operations expertise

Milliman consultants are operations experts who can help states understand the administrative implications of various policy decisions, design management plans for executing exchange requirements, and develop staffing models and budgets. In addition, we can help states determine business requirements to be supported by information systems and vendors.

Implementation and operation of an ACA compliant exchange requires personnel, systems, and processes.

Milliman consultants can help states to:

  • Determine staffing needs
  • Identify and build information systems
  • Develop processes to meet the administrative requirements of ACA and other responsibilities states adopt through the exchange.

Determining infrastructure needs is a precursor to development of an administrative budget for the exchange.



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