- Don’t TrOOP off the cliff: True out-of-pocket amount poses challenges starting in 2020
By Van Phan, Todd M. Wanta | 20 June 2018
With significant changes to Medicare Part D from the Bipartisan Budget Act of 2018 and the Centers for Medicare and Medicaid Services Final Rule, one provision from the Patient Protection and Affordable Care Act that has gone largely unnoticed is the forthcoming TrOOP Cliff in 2020, for which plan sponsors should prepare.
- Critical Point podcast, Episode 1: Healthcare waste
13 June 2018
Three members of our MedInsight team discuss minimizing healthcare waste and reducing unnecessary costs across the American healthcare system.
- A primer on prescription drug rebates: Insights into why rebates are a target for reducing prices
By Gabriela Dieguez, Maggie Alston, Samantha Tomicki | 21 May 2018
This article explains the finances associated with pharmaceutical manufacturer rebates and their impact on health insurer coverage decisions.
- 2018 Milliman Medical Index
By Christopher S. Girod, Susan K. Hart, Scott A. Weltz | 21 May 2018
Healthcare costs for the typical American family of four rose to over $28,000 in 2018.
- How healthcare providers can reap the benefits of an actuarial mindset
By Lindsy Kotecki | 11 April 2018
Healthcare provider organizations can benefit in many ways from adopting actuarial approaches, which can help them improve financial security, strengthen leverage in negotiations, and advance clinical liabilities.
- Socioeconomics and morbidity: What can consumer data tell us about social risk factors?
By Ksenia Whittal, Ally Weaver | 22 March 2018
This paper explores relationships between lifestyle factors and morbidity that the authors encountered in their experience working with consumer and administrative claims data.
- Rising risk: Maximizing the odds for care management
By Ksenia Whittal, Abigail Caldwell | 22 March 2018
This analysis examines predictive models to determine if an enhanced model can better identify individuals with rising risk relative to traditional prospective risk adjustment models.
- Opioid use disorder in the United States: Diagnosed prevalence by payer, age, sex, and state
By Stoddard Davenport, Katie Matthews | 09 March 2018
Over 25 million American adults report suffering from daily chronic pain. The increasing use of opioids in recent years has taken a human toll, leading to a rising number of overdose deaths and diagnoses of opioid use disorder.
- Is your provider organization maximizing its performance in value-based care programs?
By Rod Martin, Laurie Lingefelt | 06 March 2018
As the use of value-based reimbursement programs and the associated financial impact increases, it is important for providers to be educated on the mechanics of the program and to understand the analytical, operational, and clinical requirements to ensure success.
- Genomic testing: Cost-savings or cost-inflating for payers
By Didier Serre, Joanne Buckle | 02 March 2018
There is still some uncertainty regarding the future uptake of genomic testing and the levels of sophistication of new tests, and this article discusses some relevant considerations that can support a greater appreciation of the risks and gains to payers involved in funding these tests now.