Milliman healthcare insight

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 M. 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 M. 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 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?

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.

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