Milliman healthcare insight

29 December 2020 - By Joseph Boschert, Jonathan Wood

Brokers and carriers should recognize the value in looking at medical costs when helping members with plan selection.

28 December 2020 - By Les Kartchner, Brent Jensen

What are some considerations for employers as new COVID-19 vaccines are made available?

24 December 2020 - By John M. Pickering, David C. Lewis, Mike Hamachek, Austin Barrington

What are some of the challenges that exist when it comes to extracting useful competitive information about negotiated payment rates from a machine-readable file?

22 December 2020 - By Joanne Buckle, Dr. Sudhanshu Bansal, Abhishek Agrawal, Diana Dodu, Monika Lis

This paper focuses on studying prevalent methodologies and best practices in assessing the impact of new technology and claims costs and medical inflation from the perspective of medical insurers and is primarily aimed at non-US insurers.

22 December 2020 - By Ashlee Mouton Borcan, Jennifer O’Brien Howard, David Bahlinger, Darrell D. Spell, Michael E. Weilant

Milliman’s inaugural Critical Illness (CI) Survey represents 38 carriers and $1.4 billion in inforce premium, and explores numerous facets of the CI market.

22 December 2020 - By Ashlee Mouton Borcan, Jennifer O’Brien Howard, David Bahlinger, Darrell D. Spell, Michael E. Weilant

Milliman’s third Hospital Indemnity (HI) Survey represents 32 carriers and $1.8 billion in inforce premiums, and explores numerous facets of the HI market.

22 December 2020 - By Ashlee Mouton Borcan, Jennifer O’Brien Howard, David Bahlinger, Darrell D. Spell, Michael E. Weilant

The Milliman 2020 Critical Illness (CI) Survey represents 38 carriers and $1.8 billion in inforce premium, and explores numerous facets of the CI market.

21 December 2020 - By Michelle N. Angeloni, Michael E. Saypoff , Patricia A. Zenner

What are some opportunities, challenges, and considerations for new Medicare Advantage organizations?

21 December 2020 - By Coleen Young, Hugh Larson, Matthew J. Kramer, Noah Champagne, Raheel Sohail

While the Geographic Direct Contracting Model shares some general characteristics with the other Direct Contracting Model Options, it is a fundamentally different approach in many key respects.

21 December 2020

This year was a year like no other with COVID-19 dominating the news. It’s no surprise then that COVID-19 also dominated Milliman's top 10 list of most read articles for the year.

16 December 2020 - By Ian M. McCulla, Christopher T. Pettit, Colin R. Gray, Justin Chow

This report provides insight into the financial effects of the COVID-19 pandemic on Medicaid managed care organizations.

15 December 2020 - By Adam Barnhart, Mary G Yeh

This report evaluates the general enrollment Medicare Advantage plans available to individuals of different racial and ethnic groups in the United States.

14 December 2020 - By Julia Friedman, Mary G Yeh

This analysis focuses on mandatory supplemental benefits offered by Dual Eligible Special Needs Plans from 2017 to 2021.

14 December 2020 - By Julia Friedman, Mary G Yeh

This article focuses on mandatory supplemental benefits offered by general enrollment Medicare Advantage plans from 2017 to 2021.

09 December 2020 - By Amelia Lisi

Attempting to provide care in rural communities can often pose many different challenges.

01 December 2020 - By Robert Eaton, Missy Gordon

One strong step in making long-term care (LTC) an acceptable, insurable risk for insurance companies is to better understand the latent morbidity risk in advance of an LTC need.

01 December 2020 - By Pedro L. Alcocer, Tyler Armstrong, Robert Eaton, Pamela Laboy

This article addresses how the Medicare Advantage market responded in 2020 to the expansion of supplemental benefits.

30 November 2020 - By Adam Barnhart, Kevin Pierce

An induced utilization adjustment in the Part D Bid Pricing Tools shifts Part D risk sharing for some enhanced alternative plans, and this article highlights the importance and impact of this consideration along with details on how it could occur.

25 November 2020 - By Stacy Koron, Taylor McKinnon, Stephen Tabachnick

State Departments of Insurance have issued special rules, regulations, and guidance for insurers related to the COVID-19 pandemic. The scope of this report is limited to such information applicable to accident and health insurance only and focuses on the impact that COVID-19 regulatory actions have on product administration.

25 November 2020 - By Deana Bell, Matthew Hayes, Michelle Klein, Tracy A. Margiott

The two final rules that were released on November 20 will have sweeping impacts to Medicare Part D and Medicare Part B drug pricing.

24 November 2020 - By Mike A. Bergerson, Andrew H. Dalton, Robert Eaton, James G. Stoltzfus

This report presents the results of Milliman's survey of long-term care (LTC) insurance companies pertaining to the potential impact of COVID-19 on LTC business,

24 November 2020 - By Noah Champagne, Pamela M. Pelizzari, Alexis Villafranca

This paper discusses the methodological changes for Model Year 4 and explores the impact the changes might have on participants.

20 November 2020 - By Ellyn Russo, David V. Williams, Jennifer R. Cohen

This article considers the performance of select vaccines against various communicable diseases caused by viruses.

20 November 2020 - By Scott McEachern, Sean S. Hilton

What are some critical considerations for Medicare Part D plans as they contract with a pharmacy benefit manager?

19 November 2020 - By Fernando Mesquida, Gabriela Dieguez, Jorge Torres, Romina Santoro, Lucila Antonucci, Carolina Artuso

Es conocido que las comorbilidades se relacionan con una alta proporción de fallecimientos relacionados con el COVID-19 pero hasta ahora no había sido posible cuantificar el efecto de las mismas sobre la mortalidad segmentado por edad y género.

18 November 2020 - By Nicholas Johnson, Annie Hallum, Nick Gipe

What are some key insights into the calendar year 2021 dual eligible special needs plan landscape?

17 November 2020 - By Donna Wix, Joanne E. Fontana

This paper uses calendar year 2018 Medicare Advantage administrative claim data for enrollees aged 65 and older enrolled in plans with embedded dental coverage to determine the types of dental services used and the dental per member per month costs, as well as to study correlations between medical and dental utilization.

17 November 2020 - By Smitha Radhakrishna

The potential benefits of integrating artificial intelligence into our healthcare ecosystem and devices are numerous, including automation of tasks, analyses of patient data, and delivery of better healthcare.

16 November 2020 - By Dan Mulhern

What are the actual effects of deferred and foregone care on total spending for the commercially insured population?

12 November 2020 - By Barbara Collier, Michelle Klein

This paper examines the evolution and future of preventative services—a key component of many health insurance plans.

10 November 2020 - By Carol H. Steckel, Paul R. Houchens, Katherine Wentworth

Centers for Medicaid and Medicare Services has published a rule updating this interpretation, creating new compliance requirements for states in order to continue receiving the enhanced FMAP.

06 November 2020 - By Greg Callahan, Angela Reed

This paper explores performance guarantees best practices plan sponsors can leverage to hold their pharmacy benefit managers accountable for operational performance.

05 November 2020 - By Lalit Baveja, Samyukta Achar

This paper discusses the implementation and practical uses of wearables in the private medical insurance market.

04 November 2020 - By David V. Williams, Jacob Bryniarski

Spurred on by COVID-19, mobile health has emerged as a promising technology that could have a material impact on addressing the Quadruple Aim of healthcare.

04 November 2020 - By Ian M. McCulla, Christopher T. Pettit, Colin R. Gray, Justin Chow

This report provides insight into the financial effects of the COVID-19 pandemic on Medicaid managed care organizations.

03 November 2020 - By Smitha Radhakrishna

Digital health is expanding, and its power is especially relevant now during the COVID-19 pandemic.

29 October 2020 - By Adam Barnhart, Julia Friedman, Peter T Kissinger

This paper provides insight into benefit and premium changes made alongside revenue changing due to a star rating change and measures the change in value added through benefits and premium changes provided to beneficiaries.

21 October 2020 - By Brandy N. Millen, Amy Giese, Jason Karcher

This article provides concrete examples of how pharmacy benefit manager (PBM) fees/margin, rebates, and quality improvement activities should be considered for calculating the medical loss ratio under different PBM arrangements.

21 October 2020 - By Fernando Mesquida, Gabriela Dieguez, Jorge Torres, Romina Santoro, Lucila Antonucci, Carolina Artuso

Milliman used data from Mexico’s Ministry of Health to analyze the increase in the mortality rate produced by COVID-19 by gender, age, and the presence of comorbidities.

20 October 2020 - By Robert J. Pipich, Karin Cross, Deana Bell

This paper presents nine scenarios intended to illustrate a range of potential outcomes on 2021 Medicare Advantage and Part D risk scores.

20 October 2020 - By Andrew Bochner, Jennifer Carioto, Luis O. Maldonado Irizarry

How will COVID-19 affect a health plan’s medical loss ratio requirements in general and what are specific considerations for the commercial, Medicare Advantage, and Medicaid markets in 2020 and going forward?

13 October 2020 - By Kevin Manning, Joanne Buckle, Lalit Baveja, Alison Counihan

Kevin Manning provided an update on COVID-19 looking at the impact on the Irish private health insurance market, and Joanne Buckle presented on the impact of data analytics on the value chain for both public and private heath payers.

08 October 2020 - By Frederick (Fritz) Busch, Lindsy Kotecki, Jeffrey G. Milton-Hall

The COVID-19 Advanced Population Shift model is a tool to help understand the interconnected nature of economic changes and health insurance coverage and to project the effects on the U.S. health insurance markets.

07 October 2020 - By Rachin Aggarwal, Joanne Buckle

With the ongoing COVID-19 pandemic, it has become all the more important for insurers to manage their claims and expenses.

05 October 2020 - By Andrew H. Dalton, Gregory T. Zebolsky

This article discusses the impact that COVID-19 could have on actuarial assumptions relevant to continuing care retirement communities—specifically, mortality and morbidity—as well as other experience, including especially the number of noncontractual residents in assisted living unit and skilled nursing facility levels of care.

25 September 2020 - By Paul L. Correia

This survey provides a comprehensive analysis of new sales and inforce business for short-term disability and long-term disability insurance products in 2018 and 2019.

24 September 2020 - By Stephen P. Melek, Stoddard Davenport, Travis J. (T.J.) Gray

Telehealth visits may become part of the new “normal” for replacing, or at least supplementing, office visit-based treatment for behavioral health conditions.

15 September 2020 - By Jill S. Herbold, Nicholas Johnson

This paper discusses some challenges faced, actions taken, and the impact that the COVID-19 pandemic may have on home and community-based services for years to come.

10 September 2020 - By Susan Philip

The COVID-19 pandemic has dramatically increased the use of telehealth, so Milliman’s Susan Philip and Mei Kwong, executive director of the Center for Connected Health Policy, discuss what providers, payers, and patients should know about this virtual healthcare service.

08 September 2020 - By Noah Champagne, Andrew Yang

At the end of July, a bipartisan bill entitled "Value in HealthCare Act of 2020" was introduced to the U.S. House of Representatives proposing a number of significant changes to the Centers for Medicare and Medicaid Services Medicare Shared Savings Program and the Advanced Alternative Payment Model feature of the Medicare Access and CHIP Reauthorization Act of 2015.

04 September 2020 - By Joanne Buckle, Peter Gregor

This paper examines the strategies and business models adopted by leading players in the international private medical insurance market as well as the key success factors and capabilities required to win and sustain profitable growth in a post-COVID-19 world.

26 August 2020 - By Fernando Mesquida, Romina Santoro, Lucila Antonucci, Carolina Artuso

En Milliman hemos decidido investigar la mortalidad producida en Colombia como consecuencia del COVID-19.

24 August 2020 - By Michael Paczolt, Jill Rosenblum

Claim analytics using artificial intelligence represents a proven method to reduce claim severity and improve the efficiency of claim-handling resources.

11 August 2020 - By David Koenig, Robert J. Pipich, Michael J. Polakowski

Medicare Advantage organizations face unique challenges during the COVID-19 pandemic.

05 August 2020 - By Radhika Philip

One way higher education institutions are responding to financial challenges caused by the COVID-19 pandemic is to rethink their staffing models and reduce faculty and staff costs.

05 August 2020 - By Fernando Mesquida, Hector Gueler, Ariel Hojman

What effect will the COVID-19 pandemic have on the life insurance industry in Latin America?

04 August 2020 - By Robert D. Bachler, Nicholas Johnson, Brian Reed, Mike Hamachek

This paper summarizes the findings from Milliman’s 2020 stop-loss survey.

03 August 2020 - By Stoddard Davenport, Matt Caverly, Katie Matthews

The economic costs (both direct and indirect) of nonmedical opioid use are substantial to U.S. employers, not only due to lost productivity, but also due to increased healthcare expenditures, greater costs for workers’ compensation and disability claims, and difficulty meeting recruitment or production targets in regions that experience shortages of workers.

03 August 2020 - By Scott McEachern, Patrick Cambel

For plan sponsors, being able to pinpoint changes and areas for improvement within the pharmacy benefit manager contract can significantly reduce pharmacy program costs without having to change members’ benefits.

31 July 2020 - By David Koenig, Emily Vandermause, Rebecca Gergen

With 2022 just around the corner, it is important that Medicare Advantage organizations understand the expected impact of the Encounter Data Processing System as the single source of diagnoses for calculating risk scores and the impact this transition may have on their revenue.

29 July 2020 - By David Byron, Chris Smith

This paper explores Qualifying Advanced APM Participant status criteria and the actions accountable care organizations can take to ensure they continue to qualify for the 5% bonus, even during a pandemic.

28 July 2020 - By Rachin Aggarwal, Joanne Buckle

This paper discusses the common definitions of medical inflation, factors driving medical inflation in the short and long term and current medical inflation trends in India.

23 July 2020 - By Barbara Culley, Penny Edlund, Maureen Tressel Lewis

This paper provides information about the pursuit of quality accreditation as an essential investment that can have a positive impact on multiple health plan priorities, including quality of care, member satisfaction, and market viability.

14 July 2020 - By Bruce S. Pyenson

Emerging data from around the world suggest that nursing home residents are at exceptionally high risk for contracting COVID-19.

06 July 2020 - By Eliott Pradat , Hinarii Pichevin, Fabrice Taillieu, Jean-Philippe Boisseau

The experience of COVID-19 will probably trigger a new system for covering operating losses in the event of a health crisis.

02 July 2020 - By Jeremy D. Palmer, Christopher T. Pettit, Ian M. McCulla

This report summarizes the calendar year 2019 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.

01 July 2020 - By Kendall Carolissen, Judith Houtepen

This article describes the application of two methods for the detection of potential fraudulent claims in healthcare provider invoices.

29 June 2020 - By Dane Hansen, Andrew Bochner, Emily DeAngelis

This paper examines the reported impact of COVID-19 on preliminary rate filings among six states and D.C. that have been publicly released as of June 15, 2020.

18 June 2020 - By David Evans

Despite the uncertainty of the moment, the observations from the 2020 Northwest Benefits Survey help clarify some trends that will likely have relevance in the future.

15 June 2020 - By Susan J. Forray, Chad C. Karls

The year 2019 marked a turning point for the medical professional liability industry.

10 June 2020 - By Pamela M. Pelizzari, Stoddard Davenport, Carol Bazell

What are the challenges of interpreting data, reports, and media coverage surrounding the COVID-19 pandemic?

09 June 2020 - By Sean Silva, Eric Walters

On April 28, 2020, the Departments of Labor and Treasury and the Internal Revenue Service jointly issued guidance extending certain deadlines related to COBRA continuation coverage.

08 June 2020 - By Stephen George, Joel Brill

In view of the COVID-19 pandemic, this paper examines why, when, and how vaccines are used; highlights the vaccine development pathway; reviews previous experience with viral pandemics; and assesses ways payers can address COVID-19.

05 June 2020 - By Bruce S. Pyenson, Jim Mulshine

Artificial intelligence along with low-dose CT scans hold promise for the early detection of lung cancer, but there are challenges that come with scaling up this new technology.

02 June 2020 - By Robert L. Schmidt, Eric Walters

Each year, Milliman produces estimates of retiree health costs that are updated each year.

01 June 2020 - By Lukas Snyder, David Mike, Luke Metz, Matthew Hayes, Derek Cole

This paper explores the impact of the Part D Senior Savings Model on patient out-of-pocket costs.

01 June 2020 - By Abhishek Agrawal, Rachin Aggarwal, Jorge Torres, Bridget MacDonnell

What are some innovative healthcare technologies that can be harnessed directly by health insurers in different parts of the world?

26 May 2020 - By David Bahlinger

Research into the behavioral economics, marketing, and psychology of insurance products is business-critical for insurers.

21 May 2020 - By Deana Bell, Karen Nixon

How could prescription drug rebates at the Point of Sale affect the customer?

21 May 2020 - By Christopher S. Girod, Paul R. Houchens, David M. Liner, Andrew L. Naugle, Doug Norris, Scott A. Weltz

In 2020, the cost of healthcare for a hypothetical American family of four covered by an average employer-sponsored preferred provider organization plan is $28,653, according to the Milliman Medical Index.

19 May 2020 - By Cory Gusland, Anders Larson, Brian A. Sweatman

For any given provider organization, the impact of COVID-19 on its value-based contracts will depend largely on certain actuarial, legal, and strategic aspects of each agreement.

14 May 2020 - By Greg Callahan, Janus Desquitado

Auditing the administration of the pharmaceutical manufacturer rebate program, including dollars paid, is a proven strategy for improving plan sponsor profitability, prescription drug affordability, and the management of pharmacy benefit manager contracts.

14 May 2020 - By Rémi Bellina, Cedric Mea, Floriane Moy, Alexandre Boumezoued, Amal Elfassihi, Eve Titon

This paper explores the potential and the challenge of using BERT, a Natural Language Processing framework, to automate the task of gathering input information and assisting experts for COVID-19 studies.

13 May 2020 - By Alexandre Boumezoued

The analysis of cohort effects has long fascinated the actuarial community.

12 May 2020 - By Kristina Moorhead, Jill S. Herbold, Ben Mori, Mary Pat Stemnock, Katherine Wentworth

The COVID-19 pandemic presents unique challenges for Medicaid Home and Community-Based Services program participants.

11 May 2020 - By Sinéad Clarke, Eóin Stack

This briefing note explores the potential impact of the COVID-19 pandemic on Ireland’s insurance industry and how regulatory authorities have responded.

11 May 2020 - By Joanne E. Fontana, Annie Hallum, Catherine E Lewis

This paper outlines the options for Medicaid dental delivery systems, their current usage, and considerations for each option.

08 May 2020 - By Brian A. Sweatman, Shyam Kolli

This paper summarizes a few direct contracting strategies observed in the marketplace and identifies key areas for considerations as employers evaluate these options.

07 May 2020 - By Daniel J. Perlman

The Transparency in Coverage proposed rule is a reaction to the current opacity of healthcare pricing to most people.

05 May 2020 - By Jeffrey G. Milton-Hall, Thomas D. Murawski, Doug Norris

As knowledge around COVID-19 continues to evolve, much of the industry focus has been on this year’s costs, but this volatile and uncertain environment also presents an extraordinary challenge for health plans developing rates for 2021 commercial coverage.

05 May 2020 - By Carl X. Ashenbrenner, Darren L. Sveom

What is the potential impact that COVID-19 may have on medical professional liability and workers’ compensation claims within long-term care providers?

05 May 2020 - By Matthew D. Timm, Michelle Klein

One innovation that is driving enrollment growth for some Medicare Advantage organizations is the $0 member premium PPO.

04 May 2020 - By Les Kartchner, Troy J. Pritchett

In a system that ties healthcare coverage so tightly to employment, the implications of so many people losing their healthcare coverage are deadly serious in a pandemic.

30 April 2020 - By Luke B.G. Roth , Ben Mori, James Pettersson, Joseph Whitley, Carol H. Steckel

While large for-profit healthcare provider entities with existing capital reserves or greater access to capital markets may be able to weather the financial strain caused by the COVID-19 pandemic, other small, rural, or safety net provider entities may require additional support to keep their doors open.

29 April 2020 - By Les Kartchner, Sam Bertoch

Contributions charged to employees and retirees are an important aspect of an employer’s health and welfare benefit strategy.

27 April 2020 - By Annie Man, Barbara Dewey

What are the health insurance options available to the newly unemployed and how may this affect the size of the Affordable Care Act market?

27 April 2020 - By David Byron, Noah Champagne, Blaine Miller, Charlie Mills, Sam Shellabarger

Medicare Shared Savings Program Accountable Care Organizations are especially concerned about the potential for 2020 results to deteriorate due to COVID-19.

23 April 2020 - By Hayley M. Rogers, Charlie Mills, Matthew J. Kramer

The deferral and elimination of care during the COVID-19 pandemic could mean a net reduction in medical costs for healthcare payers by at least $75 billion and as much as $575 billion if the deferral and elimination of care continues through the end of 2020.

22 April 2020 - By Susan J. Forray, Stephen J. Koca

Modeling medical professional liability costs affected by the COVID-19 pandemic is exacerbated by tort law changes, variation in effect among specialties, and an apparent reduction in current claims that may prove to be only a delay contributing to an increase in future reported claim frequency.

21 April 2020 - By Melody Craff, Dale N. Skinner, David P. Mirkin, Francesca Hammerstrom, William J. Fox

What is the impact of COVID-19 on patterns of healthcare utilization, healthcare costs, and population health?

17 April 2020 - By Joanne Buckle

The effects of COVID-19 for specific insurers are dependent on benefit packages and policy terms and conditions, as well as government responses and macro-economic factors.

15 April 2020 - By Farzana Ismail, Natasha Su Sivarajah, Queenie Chow

This is Milliman’s first Microinsurance Supply-side Study of Asia, gathering the perspectives of the insurance industry regarding the importance of microinsurance, current practices and the enabling environment.

15 April 2020 - By Ashlee Mouton Borcan, Jennifer O’Brien Howard, Darrell D. Spell

This report presents the findings of an analysis focused on isolating and estimating the potential financial impact of COVID-19 on hospital indemnity plans in the United States.

15 April 2020 - By Penny Edlund, Maureen Tressel Lewis

Where can a health plan’s medical management team contribute to the COVID-19 response?

14 April 2020 - By Jiang Guanjun, Qiuwen Peng

Local strategies differ when it comes to fighting COVID-19, and it’s too early to know which strategy- contain or delay- works better.

13 April 2020 - By Stoddard Davenport, Matthew J. Kramer, Doug Norris, Pamela M. Pelizzari

The COVID-19 pandemic will have far-reaching implications for both short- and long-term healthcare costs in the U.S., as Milliman consultants Pamela Pelizzari, Stoddard Davenport, Doug Norris, and Matt Kramer discuss on this episode of Critical Point.

10 April 2020 - By John H. Rogers, Annie Man, Kyle Hutmaker

While no one knows what will happen with COVID-19 in 2021, in the absence of a vaccine or other curative treatment, Medicare Advantage plans may be advised to consider possible impacts of the disease well into the future.

10 April 2020 - By Andrew H. Dalton, Jeremy Hamilton, Allen J. Schmitz, Juliet M. Spector

This article examines COVID-19 implications on current long-term care (LTC) populations, short-term (2020) and long-term (beyond 2020) projection assumptions, and the effects on the LTC industry as a whole.

10 April 2020 - By Joanne E. Fontana, Alexandra Dowe

Using publicly available data for the 2020 plan year, this article highlights the landscape of dental coverage availablity in the 38 states with the Federally Facilitated Marketplace.

09 April 2020 - By Noah Champagne, Jonah Broulette, Ted Gary

The Direct Contracting model includes a unique feature allowing accountable care organizations the ability to contract with providers.

09 April 2020 - By Joanne E. Fontana, Thomas D. Murawski

This article explores the potential effects of the COVID-19 pandemic on the dental industry, considering changes in utilization of dental services that could result from the pandemic and its containment efforts as well as the economic ramifications that are already starting to occur and may last for some time.

08 April 2020 - By Katherine Wentworth, Carol H. Steckel, Jeremy Hoffman, Michael C. Cook, Greg J. Herrle

The COVID-19 pandemic is placing historic pressures on our healthcare system and coverage programs alike, and Medicaid programs are a key mechanism states are using to address these challenges.

08 April 2020 - By Jeff Anderson, Mike A. Bergerson

This paper examines COVID-19 implications on current long-term care (LTC) insured populations, short-term (2020) and long-term (beyond 2020) projection assumptions, and the effects on the LTC industry as a whole.

07 April 2020 - By Robert Eaton

How should actuaries think and spend their time in regard to the COVID-19 pandemic?

07 April 2020 - By Luis O. Maldonado Irizarry, Sylvia Hagin, Brian Regan

Newly available product design options will require actuaries to develop new tools and processes in order to assist Medicare Advantage organizations in bid development.

07 April 2020 - By Ge Bai, Bruce S. Pyenson, Gillian Woollett

Fast, convenient, cheap, accurate, and widely-used COVID-19 tests can help identify both infected individuals who should self-isolate and those who have recovered, pose low contagion risks, and can help others fight the virus.

06 April 2020 - By Andrew Jackson, Brian N. Anderson, Marc Guieb

Pharmacy benefit managers have moved quickly to develop new policies that provide guidance and assurance to their plan sponsor clients and members amid the coronavirus outbreak.

03 April 2020 - By David Bahlinger, Darrell D. Spell, Michael E. Weilant

In 2019, Milliman conducted a variety of research projects to provide insight into the state of the U.S. supplemental insurance market.

03 April 2020 - By Courtney R. White

Providers are uniquely situated to both direct and/or provide care for those in the healthcare delivery system through establishing their own health plans or contracting with existing payers.

02 April 2020 - By Stoddard Davenport

Although it is too early to analyze actual healthcare cost data for those who have been treated for COVID-19 in the United States, historical data from patients who have sought medical attention for influenza or pneumonia may be informative for understanding patient out-of-pocket costs due to treatment for COVID-19.

02 April 2020 - By Matthew J. Kramer, Pamela M. Pelizzari, Doug Norris

What are some of the cost drivers that healthcare payers may expect to encounter both now and down the road after we get through the initial surge of the COVID-19 pandemic?

01 April 2020 - By Lori E. Julga, Anne C. Kallfisch, Adam Blais

COVID-19 is changing our work environment, and the impacts not only affect our working environment on the job, but also the normal course of existing workers’ compensation claims.

31 March 2020 - By Robert Eaton, Tim F. Kempen, Stephanie Moench, Amy Pahl, Allen J. Schmitz

This report explores key risks and considerations for product innovation using the long-term care insurance industry as a case study.

31 March 2020 - By Susan Philip, Jeremy Cunningham, Mary Pat Stemnock, Ryan Reichel

This brief scopes out the issue of homelessness and housing security and Medicaid’s role in addressing the issue.

30 March 2020 - By Barbara Culley, Maureen Tressel Lewis, Andrew L. Naugle

This brief identifies five key payer functions likely to be affected by the COVID-19 pandemic and actions payers can take to ensure business continuity while enhancing their contributions to the value chain.

27 March 2020 - By Samantha J. D’Anna, Adam Feller, Matthew Hayes, Kate Herbig, Michelle Klein

This article provides an overview of the Medicare Part D Senior Savings Model and highlights key considerations for plan sponsors.

27 March 2020 - By Kenneth L. Clark, Nick Ortner

This issue brief explores the resources available to help carriers quantify the expected effect of possible Medicare Supplement medical underwriting application changes and considerations.

23 March 2020 - By Paul R. Houchens, Hans K. Leida, Lindsy Kotecki

This report looks at the different outcomes for the 50 states from the Affordable Care Act in terms of reduction of the uninsured rate, cost, and availability of health insurance coverage.

20 March 2020 - By Susan Philip, Susan E. Pantely

In the wake of the COVID-19 pandemic, could telehealth have the potential to replace some in-person services and better triage care based on needs?

18 March 2020 - By Nicholas Johnson, Christopher Kunkel, Annie Hallum

With calendar year 2021 Medicare Advantage (MA) deadlines approaching, state Medicaid agencies and MA plans offering Dual Eligible Special Needs Plans must quickly determine how to fulfill new integration requirements mandated by the Bipartisan Budget Act of 2018.

17 March 2020 - By Susan J. Forray

Healthcare providers, facilities, and MPL writers can expect direct and indirect impacts from the coronavirus pandemic—with the indirect impact possibly proving more impactful over the long term.

13 March 2020 - By Stephanie Moench, Shawn Stender

This article explores three possible future paths for long-term care (LTC) insurance funding and the associated implications for the private LTC industry.

13 March 2020 - By Jeff Anderson, Mike A. Bergerson

What are the advantages and disadvantages of long-term care policy buyouts from various stakeholder perspectives?

12 March 2020 - By Colleen Norris, Brent Jensen, Dustin J. Grzeskowiak

This paper provides an in-depth technical evaluation of Direct Contracting, based on the Centers for Medicare and Medicaid Services request for applications, along with comparisons to its sister programs—Medicare Shared Savings Program Accountable Care Organization (ACO) and Next Generation ACO.

09 March 2020 - By Joanne Buckle, Tanya Hayward, Natasha Singhal, Kishan Desai

This paper discusses the implementation and practical uses of wearable technology in the private medical insurance market.

06 March 2020 - By Joanne Buckle, Kevin Manning

Every country has its own, unique healthcare system, but within these disparate systems there are shared approaches that cross borders and languages, and we explore some of these similarities in this episode of Critical Point.

05 March 2020 - By Ashlee Mouton Borcan

For insurers, innovation is a key factor to increasing market share and improving customer retention.

05 March 2020 - By Pauric Mullan, Sinéad Clarke

This analysis compares information provided in the Quantitative Reporting Templates and Solvency and Financial Condition Reports and draws conclusions about the balance sheets and risk exposures of European health insurers, including comparisons with previous years.

03 March 2020 - By David G. Hayes, Rachel W. Killian, Shyam Kolli

What are considerations for health plans when determining capital requirements?

27 February 2020 - By Cameron Gleed, Jason Karcher, Jason J. Petroske

This white paper evaluates the implications of the risk adjustment data validation program from the perspective of issuer results with an eye for what the actual impacts say about the program’s performance.

24 February 2020 - By Brian N. Anderson, Greg Callahan

One of the most important ways plan sponsors can lower healthcare costs without significantly changing their benefits is to look for opportunities to improve their pharmacy benefit manager contract.

19 February 2020 - By Andrew Dilworth, Paul R. Houchens

This report provides an analysis of the recently released 2019 Centers for Medicare and Medicaid Services Medicaid and Children’s Health Insurance Program Scorecard.

18 February 2020 - By T. Scott Bentley, Nick Ortner

This report is Milliman’s triennial summary of estimated U.S. average utilization, billed charges, and resulting per member per month costs for organ and tissue transplants.

14 February 2020 - By Julia Friedman, Brett L. Swanson, Mary G Yeh, Jordan Cates

This report highlights key changes in member premiums and benefits for the 2020 Medicare Advantage (MA) market, as well as the contributing factors for, and the magnitude of, the increase in value added within the MA market each year from 2016 to 2020.

14 February 2020 - By Joanne E. Fontana, David Bahlinger, Michael E. Weilant

Milliman’s 2019 Dental Survey represents 50 carriers and $31.5 billion of inforce premium.

14 February 2020 - By Robert Eaton, William G. Mehilos, David Bahlinger, Michael E. Weilant

Milliman’s 2019 Worksite Life Survey represents 21 carriers and $2 billion in inforce premium.

14 February 2020 - By Robert Eaton, William G. Mehilos, David Bahlinger, Michael E. Weilant

Milliman’s 2018 Worksite Life Survey represents 13 carriers and nearly $1.7 billion in inforce premium and focuses on term, whole life, and universal life products.

13 February 2020 - By David Bahlinger, Darrell D. Spell, Michael E. Weilant

Milliman’s 2019 Accident Insurance Survey represents 42 carriers and $2.4 billion in inforce premium.

13 February 2020 - By Ashlee Mouton Borcan, Jennifer O’Brien Howard, David Bahlinger, Darrell D. Spell, Michael E. Weilant

Milliman’s 2019 Hospital Indemnity Survey represents 32 carriers and $1.3 billion in inforce premium.

13 February 2020 - By Ashlee Mouton Borcan, David Bahlinger, Jennifer O’Brien Howard, Darrell D. Spell, Michael E. Weilant

Milliman’s 2017 Hospital Indemnity Survey represents 23 carriers and $1.3 billion in inforce premium in the hospitality indemnity market.

11 February 2020 - By Charlie Mills, Chris Smith

This paper explores the minimum savings rate (MSR)/minimum loss rate (MLR) options available to accountable care organizations (ACOs) and presents perspective on what ACOs should consider when selecting the MSR/MLR under a Medicare Shared Savings Program track with downside risk.

08 February 2020 - By Christine M. Mytelka, Susan E. Pantely, Catherine E Lewis , Katherine Wentworth, Nick A Bauman

State program directors face many complex considerations as they evaluate the Healthy Adult Opportunity 1115 waiver option.

04 February 2020 - By Sam Shellabarger, Charlie Mills, Lance D. Anderson

What are the potential effects of prospective and retrospective assignment on key accountable care organization metrics under the Medicare Shared Savings Program?

03 February 2020 - By Sinéad Clarke, Diana Dodu, Tanya Hayward, Judith Houtepen, Lindsy Kotecki, Monika Lis, Erica Rode, Rong Yi

This paper sets out a ‘how-to’ guide to risk equalisation, or risk adjustment.

03 February 2020 - By Matthew J. Kramer, Erica Reijula, Sam Shellabarger

What are the similarities and differences in the financial benchmark methodology between the Direct Contracting payment model and the Medicare Shared Savings Program?

30 January 2020 - By Stoddard Davenport, Ally Weaver, Marissa North

This paper studies the prevalence of mental health and substance use disorders within commercially insured families in the United States to understand the likelihood of a household being affected by these conditions.

28 January 2020 - By Haitham Aly, Phil Ellenberg, Shyam Kolli, Josh Reinstein

This paper provides a summary of the key provisions of the price transparency final rule that apply to hospitals, briefly touching on topics that require additional consideration by parties affected by the rule.

17 January 2020 - By Kelly S. Backes, Greg J. Herrle, Douglas I. Rodrigues

This paper explores the various components of Medicare Advantage revenue, avenues Medicare Advantage organizations may explore to increase their Part C and Part D revenues, and key considerations for each approach.

17 January 2020 - By Jennifer O’Brien Howard, Stacy Koron

Small companies in the supplemental health products market need to understand the unique challenges these products present in order to compete effectively.

16 January 2020 - By Kelly S. Backes, Katherine N. Kroening, Douglas I. Rodrigues , Gokce Yilmaz

This paper provides a brief overview of the upcoming end-stage renal disease Medicare Advantage eligibility change and key questions each Medicare Advantage organization should consider when planning for 2021.

15 January 2020 - By Joseph Boschert, Jim Hong, Kyle Ligon

This paper analyzes Medicare Advantage claims and membership data to evaluate the risk and costs associated with opioid use disorder.

10 January 2020 - By Jill S. Herbold, Melanie K. Kuester

This paper discusses several decision points and considerations for states evaluating a single preferred drug list requirement.

08 January 2020 - By Christopher Kunkel, Jordan Pettibon

Which options do Medicare Advantage enrollees look at most when choosing a plan?

07 January 2020 - By Lindsy Kotecki, Stan Westrom

This case study discusses the actuarial implications of one potential Medicare buy-in option.

07 January 2020 - By Anna Bunger, Madeleine Cline, Katherine M. Holcomb

This study provides claim cost benchmarks to illustrate the magnitude and distribution of specialty medication costs adjudicated under both the pharmacy and medical benefit for a commercially insured population.

07 January 2020 - By Ben Mori, Tyler Schulze, Jason A. Clarkson

This paper contains a summary of the key elements of the Medicaid Fiscal Accountability Regulation’s proposed changes to supplemental payments that may be relevant to state Medicaid agencies.

06 January 2020 - By Joseph Boschert, Janet Jennings, Robert L. Schmidt

This paper examines the various connections between health and wealth as well as the repercussions of ignoring those connections.

06 January 2020 - By Joseph Boschert, Janet Jennings, Robert L. Schmidt

People are looking for ways to protect their long-term health and wealth, and they expect their financial advisers to create more comprehensive financial plans that will help them achieve this goal.

06 January 2020 - By Lalit Baveja, Alison Counihan, Tanya Hayward, Monika Lis, Neha Taneja

What are the best practices for designing and implementing a wellness programme?

03 January 2020 - By Mike Gaal, Jason Karcher

How much will single-payer healthcare in the United States cost and how will it be paid?

17 December 2019 - By Jiang Guanjun

In China, the Action Plan for Promoting the High Quality Development of the Healthcare Industry 2019-2022 promotes, in the development of health insurance products, the use of special needs medical services, innovative medical technologies and drugs and high-end medical devices as well as health intervention procedures.

10 December 2019 - By Noah Champagne, Dane Hansen

As the prevalence of partnerships between payers and providers increases, it is critical for payers to monitor and track emerging experience and communicate these results to partner providers.

05 December 2019 - By Joanne Buckle, Tanya Hayward, Natasha Singhal

The value of care categories assess the validity and efficacy of treatments in relation to associated conditions to inform where groups of patients may benefit from alternative pathways.

05 December 2019 - By David V. Williams, Donna Wix

What are the prevalence rates for rheumatoid arthritis, ulcerative colitis, and hemophilia as compared to zombie statistics commonly cited?

04 December 2019 - By Julia Friedman

What are the advantages of adding a segmented plan to a Medicare Advantage organization portfolio and what are the bid requirements for segmented plans?

26 November 2019 - By Jason A. Clarkson, Zachary Fohl, Paul R. Houchens

These state profiles summarize insurer financials, marketplace enrollment, and federal assistance provided to households purchasing insurance coverage through the insurance marketplaces, incorporating recently released data from the 2019 open enrollment period and estimated 2019 effectuated enrollment.

26 November 2019 - By Robert W. Beal, Tasha S. Khan

This report presents the results of Milliman’s 2019 Annual Survey of the U.S. Individual Disability Income Insurance Market.

22 November 2019 - By Jeremy Hamilton, Allen J. Schmitz, Ali M Yeager

How does spousal contagion influence long-term care needs?

15 November 2019 - By Lalit Baveja, Carol Bazell, Alison Counihan

The successful adoption of value-based care in the Middle East faces important challenges.

08 November 2019 - By Jeremy Cunningham, Mat DeLillo

This paper discusses the risks and considerations of changing Medicaid’s funding formula to a general block grant structure.

04 November 2019 - By Eric Buzby, Catherine M. Murphy-Barron

In the past two years, CMS has expanded the types and flexibility of supplemental benefits Medicare Advantage organizations (MAOs) can offer enrollees. This issue brief discusses the implications of actions taken by plans in response.

01 November 2019 - By Jacob Bryniarski, Joanne E. Fontana

This article, using publicly available CMS data, explores the current landscape of dental benefits offered in Medicare Advantage plans, discussing the ramifications for insurers and consumers alike.

01 November 2019 - By Dustin J. Grzeskowiak, Darin Muse, Daniel J. Perlman

There may be some uncertainty for plans and consumers alike around the Quality Information Rating Bulletin—specifically, what the quality scores represent, how they are developed, and/or how they may be used now or in the future.

29 October 2019 - By Dan Freeman, Mike Gaal, Cory Gusland, Jennifer Janvrin

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

24 October 2019 - By Jason Karcher, Jason J. Petroske, Cameron Gleed

This article breaks down the purpose and technical details of the Patient Protection and Affordable Care Act risk adjustment data validation audit.

24 October 2019 - By Sean S. Hilton, Thomas D. Murawski

Insurers who forgo periodic, comprehensive analyses to ensure the appropriateness of their dental rating manuals risk reduced product marketability (if rates are too high) or non-profitability and adverse selection (if rates are too low).

18 October 2019 - By Benjamin J. Diederich, William J. Fox, Brent Jensen

Employers should adjust health plan options for morbidity in order to reduce the selection bias.

17 October 2019 - By Joanne Buckle, Alison Counihan, Tanya Hayward, Nicholas Kallis, Bridget MacDonnell, Kevin Manning, Neha Taneja

This guide can assist managers in thinking through the practical components of a population health management programme, from overall objectives and definitions, through to the people, processes and technology enablers that are so critical for success.

15 October 2019 - By Michelle Klein, Matt Kranovich

This paper highlights several key changes to Medicare Plan Finder— and potential unintended consequences— and offers suggestions as to how those changes could potentially affect Medicare Advantage Organizations.

14 October 2019 - By Joanne E. Fontana

New trends in dental care and insurance coverage are aimed at improving the patient experience as Milliman’s Joanne Fontana discusses.

10 October 2019 - By Ankush Aggarwal, Joanne Buckle, Tanya Hayward

This report provides an updated view of National Health Service England prescription drug costs for financial year 2018/2019.

08 October 2019 - By Stoddard Davenport, Stephen P. Melek

Milliman has been retained by a number of state agencies to advise them on appropriate methods by which to conduct parity compliance analyses and audits for nonquantitative treatment limitations.

23 September 2019 - By Rachin Aggarwal, Abhishek Agrawal

This article examines how the concept of a standard health product would benefit various stakeholders in India.

16 September 2019 - By Mike Hamachek, Christopher Kunkel

What happened in the first year of Merit-Based Incentive Payment System reporting?

11 September 2019 - By Carol Bazell, Dane Hansen, Pamela M. Pelizzari, Bruce S. Pyenson

This report discusses the economic and clinical burden of new osteoporotic fractures that occurred in 2015 in the Medicare fee-for-service population using information from a large administrative medical claims database.

09 September 2019 - By Joanne Buckle, Tanya Hayward

This paper outlines some of the key considerations associated with using real-world data to widen the evidence base used in economic evaluations.

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

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.

20 August 2019 - By Rachin Aggarwal, Joanne Buckle, Vidhi Gupta, Neha Taneja

This paper looks at the key provisions of the Mental Healthcare Act, 2017, mental illness prevalence, supply-side indicators and the current treatment gap.

20 August 2019 - By Robert Eaton

Combination products provide valuable, and often substantial, health insurance coverage in the framework of a life insurance or annuity policy.

01 August 2019 - By Tim F. Kempen, Allen J. Schmitz

This report presents the results of our sixth triennial long-term care insurance valuation survey.

11 July 2019 - By Brian N. Anderson, Greg Callahan, Michael DiPrima

This article describes the origin of pharmacy benefit managers (PBMs), how claims are processed, and ways in which blockchain could disrupt the PBM marketplace.

08 July 2019 - By Ankush Aggarwal, Joanne Buckle, Pravin Harodia

What are the current and potential uses of generalised linear modelling in the Indian health market?

09 October 2018 - By Andrew Gaffner, Barbara Collier, Joseph Boschert

Screening and risk assessment are critical to exercising sound clinical judgment and making effective care decisions regarding opioid use disorder.

18 September 2018 - By Robert W. Beal, Tasha S. Khan

This report presents the results of Milliman’s 2018 Annual Survey of the U.S. Individual Disability Income Insurance Market.

03 August 2016 - By Robert Eaton, John Cutler , John O'Leary, Bruce Stahl

What are some ideas to address the on-coming expansion of long-term care needs in the U.S.?

01 October 2015 - By Juliet M. Spector, Brian H. Studebaker, Ethan Menges

This paper outlines the general steps and considerations for designing, implementing, and measuring results of existing payment reform models.