Unrelenting healthcare cost increases and fundamental healthcare system changes scheduled to occur in 2014 under the Patient Protection and Affordable Care Act (PPACA) are creating unprecedented challenges and new opportunities for employers and trusts.

Milliman is the leading consultant to health plans and providers. We utilize the methods, tools and general knowledge gained from that expertise in the advice we provide to our employer and trust clients. The result is a level playing field, where our employer and trust clients can more meaningfully evaluate their benefits plans and negotiate more powerfully with insurers.

For more than 50 years, Milliman has been providing insurers with its annually updated Health Cost Guidelines™ (HCGs), which incorporate more than $2 million of annual research investment and a detailed database reflecting over 21 million lives and 75% of national inpatient admissions. Today, more than 100 insurers rely on Milliman to provide the most up-to-date understanding of health costs. For employee benefit plans, we use the HCGs to:

• Calculate the impact of benefit design changes.
• Develop manual rates for plan pricing.
• Compare, at a detailed service level, a group's claim experience to actuarial adjusted benchmarks. The benchmarks are adjusted to reflect the covered group's benefits design, demographic profile and geographic profile (at the Metropolitan Statistical Area—MSA—level). We then identify plan areas that are performing poorly and work with the employer’s health plan to improve results through better utilization and provider reimbursement management.

We also:

• Provide advice on the strategic implications of PPACA.
• Provide data warehousing services through MedInsight.
• Evaluate benefit costs and program design.
• Calculate long-term projections and valuations of health and welfare liabilities.
• Evaluate vendors, manage performance and negotiate contracts.
• For larger employers, develop best practice benchmarks for acute inpatient hospital services through the Hospital Inpatient Profiler (HIP). These results are used to identify well and poor performing hospitals. We then work with employers' health plans and relevant hospitals to improve performance.
• Provide Chronic Condition Hierarchical Groups (CCHGs) analyses to larger employers. These are a new and innovative patient-centered way of analyzing healthcare utilization and costs. The CCHG system assigns patients to unique categories using a clinically relevant hierarchy that places similar patients in the same group based on how doctors make treatment decisions. The effect is to remove members having "confounding co-morbidities" from each group and place these in their own groups. Results are used to proficiently identify members for disease management programs and analyze trend from a clinical perspective.
• Provide compliance support, including review of plan documents, communications and SPDs, nondiscrimination testing, research and other related tasks.
• Provide claim audits, dependent audits, and other evaluations of plan and vendor performance.
• Provide Pharmacy Benefit manager (PBM) audits.