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.
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?
03 December 2019 - By Ankush Aggarwal, Joanne Buckle, Pravin Harodia
What are the current and potential uses of generalised linear modelling in the Indian health market?
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?
18 November 2019 - By Tim F. Kempen, Allen J. Schmitz
This report presents the results of our sixth triennial long-term care insurance valuation survey.
15 November 2019 - By Robert Eaton
Combination products provide valuable, and often substantial, health insurance coverage in the framework of a life insurance or annuity policy.
15 November 2019 - By Lalit Baveja, Carol Bazell, Alison Counihan
The successful adoption of value-based care in the Middle East faces important challenges.
13 November 2019 - 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.
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 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.
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.
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.
23 September 2019 - By Mike Hamachek, Christopher Kunkel
What happened in the first year of Merit-Based Incentive Payment System reporting?
23 September 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.
23 September 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.
23 September 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.
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.
- 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.