Healthcare costs

Population health management program development

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• NADAC-plus: An emerging paradigm in pharmacy pricing?

  By Kevin P. Pierce, Andrea Sheldon | 14 November 2018

  This paper introduces national average drug acquisition costs (NADAC) and describes the opportunities and limitations of using NADAC as a basis for pharmacy pricing.

• Preference-sensitive surgical procedures for preference-sensitive conditions

  By Kathryn V. Fitch, Carol Bazell, Sumudu Dehipawala | 24 September 2018

  This paper focuses on 15 preference-sensitive surgical procedures that may be performed to treat certain preference-sensitive conditions that have surgical treatment options.

• The changing landscape of out-of-network reimbursement

  By David C. Lewis | 19 September 2018

  To avoid unfavorable outcomes, it is important to evaluate the methodology used for setting out-of-network reimbursement levels and to identify savings opportunities.

• Alternative payment model financial settlements: Preparing for and learning from the process

  By Christine Ferro, Maggie Alston, L. Daniel Muldoon, Pamela M. Pelizzari | 17 September 2018

  This paper focuses on alternative payment model reimbursement methodologies through the lens of the Centers for Medicare and Medicaid Services Oncology Care Model as an illustrative case study.

• Leveraging drug rebates for medical stop loss product innovation

  By Kevin P. Pierce, Thomas D. Murawski | 11 September 2018

  This paper explores potential innovations and key strategies for medical stop loss insurers.

• Fiscal year 2019 HRRP impact to hospitals

  By James Lucas | 11 September 2018

  This paper describes the changes that are coming with the Hospital Readmission Reduction Program and explores what the likely effects will be.

• International best practice benchmarks

  By Joanne Buckle, Tanya Hayward | 05 September 2018

  Milliman’s International Best Practice Benchmarks help quantify potentially avoidable admissions and beddays within a healthcare system to identify potential value opportunities.

• Pharma APMs: Can the industry learn to play well with others?

  By Maggie Alston, Bruce S. Pyenson | 05 September 2018

  The dynamics of alternative payment models suggest a potential win for insurers, pharmaceutical manufacturers, and patients through an emphasis on reducing cost and improving outcomes.

• The short-term/limited-duration insurance rule and the potential impact on health insurance markets

  By Erik Huth, Jason Karcher | 31 August 2018

  This brief analyzes the provisions of the final short-term/limited-duration insurance rule, the accompanying commentary, and the potential implications to individual insurance markets.

• Health and Group Benefits News and Developments, July 2018

  By Christopher S. Girod, Susan K. Hart, Scott A. Weltz, Sean Silva, Jennifer M. Fleck | 26 July 2018

  Health and group benefits news and developments in the United States.

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