Healthcare costs

Population health management program development

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• Congress asked nine questions about single payer. Here are 27 answers.

  15 March 2019

  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.

• Costs and comorbidities of opioid use disorder

  By Stoddard Davenport, Ally Weaver, Matt Caverly | 04 March 2019

  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.

• Considerations when adding ride-sharing to a healthcare benefit plan

  By Deana Bell, Cameron Gleed | 22 February 2019

  An increasing number of payers and healthcare organizations are turning to ride-sharing services such as Uber or Lyft for non-emergency medical transportation.

• Strategies employers can consider to understand and combat opioid abuse and misuse

  By Barbara Culley, Christine Castle | 22 January 2019

  How can employers prepare for and address opioid abuse and misuse?

• Multiemployer Review: Know the specifics of your health and welfare stop-loss policy

  By Sean Silva, David Stoddard | 21 January 2019

  As fiduciaries to health and welfare trusts, trustees must understand the details regarding their stop-loss carrier contracts in order to ensure the trust is receiving the most competitive price while also receiving sufficient protection against large claims in order to maintain sufficient trust assets.

• Computed tomography colonography less costly than colonoscopy for colorectal cancer screening of commercially insured patients

  By Judy Yee, Tia Goss Sawhney, Bruce S. Pyenson, Michele M. Berrios | 21 December 2018

  For colorectal cancer screening, does computed tomography have a cost advantage relative to optical colonoscopy for the commercially insured U.S. population?

• 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.

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