Considering trend guarantees in your next TPA selection analysis
There is increased interest from both employers and third-party administrators (TPAs) in incorporating medical trend guarantees into TPA selection analyses.
Blockchain and insurance
This report explains blockchain technology together with some of its current uses.
Taking on Medicare Part D risk: Provider perspective
This article summarizes the key issues providers need to consider before taking on Part D risk, an increasingly common ask from Medicare Advantage organizations, and highlights some of the complexities and common barriers observed when advising provider clients on their strategies for Part D risk.
BPCI Advanced: Key considerations for prospective model participants
For organizations interested in pursuing the Bundled Payments for Care Improvement Advanced model, do the potential rewards for participating offset the risks and costs associated with that participation?
Hang on tight! Why maintaining a zero-dollar MA-PD premium plan is worth the effort
What happens to membership in Medicare Advantage-Prescription Drug plans with a zero-dollar premium when a premium is added?
Impact of offsetting midyear list price and rebate reductions in Medicare Part D
The structure of the Medicare Part D program produces interesting, and sometimes counterintuitive, financial outcomes when drug list prices are decreased and rebates are eliminated.
Observations on Emergence of Earnings under US GAAP Targeted Improvements
This paper illustrates the potential impacts of Accounting Standards Update 2018-12, Targeted Improvements for Long-Duration Contracts relative to current US GAAP accounting with respect to four blocks of business: level term insurance, single premium immediate annuities, long-term care insurance and universal life insurance.
Medicare Advantage Uniformity Flexibility benefit offerings
A review of the Uniformity Flexibility benefits offered during the contract year 2019 plan year to provide insight into the market dynamics regarding this new benefit design.
HHS’s proposed modification of pharmacy rebate safe harbors
This paper focuses on potential implications of the proposed modifications to safe harbor regulations for state Medicaid agencies and the Children’s Health Insurance Program.
Milliman Combination Product Experience Study
Milliman announces the results of the first-of-its-kind, industry-wide study that examines insurers’ experience with combination products-- those that couple life or annuity policies with Long-Term Care or Chronic Illness riders.
Putting a price tag on health
Value in healthcare is about more than just reducing costs—improving health outcomes is a key part of the cost/value equation.
Health and Group Benefits News and Developments, March 2019
Health and group benefits news and developments in the United States.
Congress asked nine questions about single payer. Here are 27 answers.
Reflecting the many unique ways that the federal and state governments fund and regulate American healthcare, Milliman has identified three different single-payer scenarios, ranging from least disruptive to most disruptive compared to the status quo.
What’s in the Part D Payment Modernization Model Request for Application: More questions than answers
With less than one month to respond, many details unknown, and multiple impending changes to the Part D program, the Part D Payment Modernization Model’s Request for Applications leaves more questions than answers.
Could 2019 be the year of MLR rebates for ACA issuers in the individual market?
As medical loss ratios (MLR) decrease, individual ACA issuers need to start thinking about something that has been mostly irrelevant to them until now—MLR rebates.
Critical Point Episode 10: What is a Critical Point anyway?
What is a critical point and why would we name Milliman’s podcast after this mathematical concept?
Costs and comorbidities of opioid use disorder
This study assesses the prevalence and costs associated with comorbid chronic medical conditions among individuals with diagnosed opioid use disorder (OUD) and opioid super-users without diagnosed OUD.
Webinar: Seven key challenges for Medicaid states considering alternative payment models
Alignment with managed care
Variation in benefits and coordination with other payers
Download the webinar slides
Seven key challenges for Medic
Evaluation of State Medicaid Scorecard Data
An analysis of the recently announced Centers for Medicare and Medicaid Services Medicaid and Children’s Health Insurance Program Scorecard with a primary focus on the Scorecard’s State Health System Performance quality metrics.
“Pathways to Success” MSSP final rule: Financial benchmark
This paper discusses the changes to the financial benchmark methodology that measures the gross savings or losses of an accountable care organization under the Medicare Shared Savings Program.