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Objectivity matters. Today, more than ever.

Independent for over 70 years, Milliman delivers market-leading services and solutions to clients worldwide. With no agenda, other than getting it right.

Through a team of professionals ranging from actuaries to clinicians, technology specialists to plan administrators, we offer unparalleled expertise in employee benefits, investment consulting, healthcare, life insurance and financial services, and property and casualty insurance.

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  • 19 February 2019 — Captive Review
    The 2018 Captive Review Power 50
  • 14 September 2018 — Wall Street Journal
    Florence flood threat heightened by underinsured homeowners
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Long-term care consulting

We offer unmatched depth and breadth of knowledge in long-term care.

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Expanding access to quality healthcare for a California community.

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Helping clients understand and navigate retirement risk

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Recent stories

  • See the forest for the trees
  • Remaining a vibrant domicile
  • Milliman FRM Market Commentary: December 2019
  • Monthly Benefit News and Developments, December 2019
Critical Point podcast

A Milliman podcast covering topics in health, benefits, and more

insightMilliman insight

All insightHealthcareEmployee Benefits and InvestmentInsuranceRisk Management and Financial Services
Medicaid managed care: The series
Medicaid managed care: The series
Pass-through payment guidance in final Medicaid managed care regulations
Pass-through payment guidance in final Medicaid managed care regulations
Medicaid risk-based managed care: Analysis of administrative costs for 2015
Medicaid risk-based managed care: Analysis of administrative costs for 2015

Medicaid

  • Early thoughts on the Primary Care First model

    By Raheel Sohail, Cory Gusland, Daniel Henry | 22 August 2019

    This paper explores key model features of the Center for Medicare and Medicaid Innovation’s Primary Care First, a new voluntary payment model focused on primary care.

  • Medicaid managed care financial results for 2018

    By Jeremy D. Palmer, Christopher T. Pettit, Ian M. McCulla | 28 June 2019

    This report summarizes the calendar year 2018 experience for selected metrics of organizations reporting Medicaid experience under the Title XIX Medicaid line of business on the National Association of Insurance Commissioners annual statement.

  • New CMS guidance for Medicaid managed care medical loss ratio calculations

    By Paul R. Houchens, Ian M. McCulla, Amber Kerstiens | 06 June 2019

    The May 15, 2019, Informational Bulletin from the Centers for Medicare and Medicaid Services focuses on the responsibilities of a subcontractor in providing data and the proper accounting of subcontractor payments for purposes of medical loss ratio reporting.

  • Medicaid adult dental reimbursement

    By Joanne E. Fontana, Catherine E. Lewis, Tory E. Carver | 09 May 2019

    This paper explores the relationships among a state’s adult Medicaid dental benefit, provider reimbursement, and dental care utilization rates.

  • HHS’s proposed modification of pharmacy rebate safe harbors

    By Christine M. Mytelka | 22 March 2019

    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.

  • Webinar: Seven key challenges for Medicaid states considering alternative payment models

    By Rebecca L. Johnson, Anders Larson, Zach Hunt | 28 February 2019

    Webinar Agenda Attribution Claims volatility Risk adjustment Alignment with managed care Quality metrics Service carve-outs Variation in benefits and coordination with other payers  Download the webinar slides Related article Seven key challenges for Medic

  • Evaluation of State Medicaid Scorecard Data

    By Andrew Dilworth, Paul R. Houchens | 26 February 2019

    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

    By Jill S. Herbold, Cory Gusland, Charlie Mills, Matthew J. Kramer | 22 February 2019

    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.

  • An end to manufacturer rebates as we know them today?

    By Deana Bell, Jennifer Carioto, Matthew Hayes | 15 February 2019

    The proposed rule to make drug manufacturer rebates no longer protected under the Anti-Kickback Statute has broad impacts to federally funded prescription drug programs, especially Medicare Part D.

  • Pathways to Success MSSP final rule: Winners and losers

    By Anders Larson, Cory Gusland | 14 February 2019

    This paper examines the Medicare Shared Savings Program’s (MSSP) final rule from the perspective of different accountable care organization (ACO) situations to help readers understand how the MSSP rule might affect different ACOs.

See More Articles

  • 08 February 2019

    Changing the rebate game: A primer on the HHS proposed rule to shift drug rebates to POS

    This paper discusses the implications of recently proposed rebate regulation to various Medicare Part D program stakeholders.

  • 29 January 2019

    Seven key challenges for Medicaid states considering alternative payment models

    This article focuses on some of the challenges that Medicaid payers (including states and managed care organizations) face when trying to establish alternative payment models with providers.

  • 14 January 2019

    Critical Point Episode 8: Puerto Rico after the hurricane: Managing Medicaid in the face of a natural disaster

    Managing Medicaid in Puerto Rico after Hurricane Maria was part of Jose Carlo’s job, but it was also personal for the Milliman consultant.

  • 19 December 2018

    Medicaid’s winding path through Institutions of Mental Disease

    The Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act provides a simpler way for states to include Institutions of Mental Disease facilities in their fee-for-service and managed care delivery models—a state plan amendment.

  • 08 November 2018

    Are you ready for New York State Medicaid value-based payment models?

    This paper provides a high-level overview of the New York State value-based payment models, discusses the opportunities and challenges for providers considering participation in them, and highlights the needs for sophisticated actuarial, financial, and legal expertise to address the inherent business, legal, and operational risks.

  • 30 October 2018

    Approved Medicaid state directed payments: How states are using §438.6(c) Preprints to respond to the managed care final rule

    This paper provides a background on state directed payment arrangements based on our review of §438.6(c) “Preprints” and supporting documentation for arrangements approved by the Centers for Medicare and Medicaid Services as of August 15, 2018.

  • 04 June 2018

    Medicaid managed care financial results for 2017

    This report summarizes the calendar year 2017 experience for selected financial metrics of organizations reporting Medicaid experience under the Title XIX Medicaid line of business on the National Association of Insurance Commissioners annual statement.

  • 11 May 2018

    Medicaid buy-in: Section 1332 Innovation Waivers, state options, and top ten considerations

    Medicaid buy-ins are currently getting states’ attention.

Healthcare

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See all topics
  1. Healthcare
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  • Featured videos

    • Medicaid - ThumbnailUnderstanding healthcare costs: Medicaid(4:44)
    • Story behind MMI - ThumbnailThe story behind the Milliman Medical Index(1:36)
    • Unbiased perspective - ThumbnailAn unbiased perspective on healthcare policy decisions(1:17)
    See all video
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For more than seven decades, Milliman has combined technical expertise with business acumen to create elegant solutions for our clients. 

Today, we are helping companies take on some of the world's most critical and complex issues, including retirement funding and healthcare financing, risk management and regulatory compliance, data analytics and business transformation.


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