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Newly diagnosed hepatitis C in the U.S. commercially insured population before and after the 2012 implementation of expanded screening guidelines
By Gabriela Dieguez, Bruce S. Pyenson, Christine Ferro | 30 July 2018
This research compares the demographics, comorbidities, and medical costs of newly diagnosed patients and those who were previously diagnosed with HCV infection after the Centers for Disease Control and Prevention expanded its HCV testing recommendations to target adults born between 1945 and 1965.
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Health and Group Benefits News and Developments, July 2018
By Christopher S. Girod, Susan K. Hart, Scott A. Weltz, Sean Silva, Jennifer M. Fleck | 26 July 2018
Health and group benefits news and developments in the United States.
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Critical Point podcast, Episode 2: Alternative Payment Models 101
By Pamela M. Pelizzari | 24 July 2018
A discussion about alternative payment methods, bundled payment, ACOs, and more.
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The Swiss Army Knife of medical tests
By Dr. James L. Mulshine, Bruce S. Pyenson | 13 July 2018
Jim Mulshine joins Milliman’s Bruce Pyenson for a Q&A to discuss lung cancer and provide a medical and actuarial take around an alternative form of disease management.
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Value proposition of teledentistry: Cost savings, improved services, and more
By Joanne E. Fontana, Donna Wix | 05 July 2018
This article explores the value proposition that teledentistry could provide to dental plans, dental providers, disease management programs, and populations lacking adequate oral healthcare.
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First-quarter financial results for composite of medical professional liability specialty writers
By Eric J. Wunder, Bradley J. Parker | 05 July 2018
This article summarizes some key financial results for medical professional liability specialty writers from the first quarter of 2018.
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Why accurate claims coding for MSSP ACOs has become increasingly important
By Jonah Broulette, Noah Champagne, Kathryn V. Fitch | 26 June 2018
This brief explains how benchmark year 3 risk scores affect the benchmark calculation for Medicare Shared Savings Program (MSSP) renewals, presents an overview of the prior and new MSSP benchmark calculations, and illustrates how the change can affect an accountable care organization’s benchmark under various scenarios.
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Don’t TrOOP off the cliff: True out-of-pocket amount poses challenges starting in 2020
By Van Phan, Todd M. Wanta | 20 June 2018
With significant changes to Medicare Part D from the Bipartisan Budget Act of 2018 and the Centers for Medicare and Medicaid Services Final Rule, one provision from the Patient Protection and Affordable Care Act that has gone largely unnoticed is the forthcoming TrOOP Cliff in 2020, for which plan sponsors should prepare.
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Underwriting income continues to decline, offset by 2017 investment gains
By Susan J. Forray, Chad C. Karls | 19 June 2018
The medical professional liability industry remains in a financial position roughly consistent with where it has been for the past five years.
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Critical Point podcast, Episode 1: Healthcare waste
13 June 2018
Three members of our MedInsight team discuss minimizing healthcare waste and reducing unnecessary costs across the American healthcare system.
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Are Medicare Advantage plans ready for the high costs of long-term care?
By Christopher J. Giese, Allen J. Schmitz | 12 June 2018
There are a number of factors that may influence how Medicare Advantage plans offer and price new long-term care benefits.
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The impact of the $0 individual mandate penalty
By Andrew Bourg, Fritz Busch, Stacey V. Muller | 08 June 2018
Understanding the impact of the $0 individual mandate penalty on the health insurance risk pool is important to both insurers offering ACA-compliant products and state policymakers evaluating its alternatives.
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Product Governance
By Neha Taneja | 05 June 2018
A robust product governance process can reduce mis-selling and complaints, and increase policyholder confidence in the market.
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Medicaid managed care financial results for 2017
By Jeremy D. Palmer, Christopher T. Pettit, Ian M. McCulla | 04 June 2018
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.
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A primer on prescription drug rebates: Insights into why rebates are a target for reducing prices
By Gabriela Dieguez, Maggie Alston, Samantha Tomicki | 21 May 2018
This article explains the finances associated with pharmaceutical manufacturer rebates and their impact on health insurer coverage decisions.
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2018 Milliman Medical Index
By Christopher S. Girod, Susan K. Hart, Scott A. Weltz | 21 May 2018
Healthcare costs for the typical American family of four rose to over $28,000 in 2018.
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Commercial health insurance: Overview of 2016 financial results and emerging enrollment and premium data
By Paul R. Houchens, Jason A. Clarkson, Jason Melek | 17 May 2018
This report provides a detailed review of the commercial health insurance industry’s financial results in 2016 and evaluates changes in the market’s expense structure and enrollment prior to relative years.
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Summary of key results from 2017 U.S. Group Disability Market Survey
By Jennifer M. Fleck, Paul L. Correia | 15 May 2018
The 2017 U.S. Group Disability Market Survey covers employer-paid and employee-paid short-term disability and long-term disability insurance products, and includes an analysis of premiums, cases, and covered lives from new sales and inforce business in 2016 and 2017.
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National Health Protection Scheme: Short-term and long-term challenges
By Abhishek Agrawal | 14 May 2018
The short-term and long-term challenges of India’s National Health Protection Scheme should be reviewed and tackled differently by each stakeholder- the central government, state governments, the provider community, and the insurer community.
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Medicaid buy-in: Section 1332 Innovation Waivers, state options, and top ten considerations
By Paul R. Houchens, Christine M. Mytelka, Susan Philip | 11 May 2018
Medicaid buy-ins are currently getting states’ attention.