- Using the Milliman Advanced Risk Adjusters (MARA) tool in the UK PMI market
By Joanne Buckle, Tanya Hayward, Kishan Desai | 10 December 2018
Can a risk adjustment algorithm do an effective job in population risk stratification, given data and system challenges, such that there can be a better understanding of member risk profiles within the context of UK private medical insurance?
- Proposed updates to pass-through payment guidance
By Andrew Gaffner, Christine M. Mytelka | 06 December 2018
The updates to Medicaid managed care pass-through payment guidance promulgated in 42 CFR 438.6 appear to simplify and streamline the approval process.
- Proposed reforms to Part B Rx for the Medicare Fee-for-Service program
By Mark Koransky | 03 December 2018
This paper outlines proposals to shift certain drugs from Part B to Part D and to change Medicare’s system for administering Part B drugs.
- Critical Point podcast, Episode 4: A primer on telehealth in the U.S.
By Susan Philip | 26 November 2018
This primer on telehealth (telemedicine) looks at the way in which the technology can be used to deliver healthcare in the U.S., and where it holds promise for improving patient outcomes.
- Barriers and potential paths for biosimilars in the United States
By Jennifer Carioto, Harsha Mirchandani | 16 November 2018
Biosimilars can potentially reduce drug costs if barriers in the U.S. are removed or diminished.
- Dental coverage in Medicare Advantage Plans: Nationwide market landscape
By Joanne E. Fontana | 16 November 2018
Dental services aren’t included in standard Medicare benefits, leaving seniors and other Medicare recipients with a dental coverage gap.
- NADAC-plus: An emerging paradigm in pharmacy pricing?
By Kevin P. Pierce, Andrea Sheldon | 14 November 2018
This paper introduces national average drug acquisition costs (NADAC) and describes the opportunities and limitations of using NADAC as a basis for pharmacy pricing.
- Are you ready for New York State Medicaid value-based payment models?
By Brett Friedman, Rebecca L. Johnson, Howard Kahn | 08 November 2018
This paper provides a high-level overview of the New York State value-based payment models, discusses the opportunities and challenges for providers considering participation in them, and highlights the needs for sophisticated actuarial, financial, and legal expertise to address the inherent business, legal, and operational risks.
- Benefits Perspectives: November 2018
By Joe Becker, Michelle N. Angeloni, Brandy N. Millen, Rebekah D. Bayram | 05 November 2018
This issue of Benefits Perspectives features an article comparing and contrasting three volatility-based investment strategies and discussing the implications of applying them in a retirement plan and an article about managing pharmacy costs through focused analytics.
- Pathways to Success: MSSP proposed rule: Integrity
By Jason Karcher, Brian A. Sweatman | 01 November 2018
This paper discusses ways in which accountable care organizations have been identified by the Centers for Medicare and Medicaid Services (CMS) as weakening integrity and how CMS is proposing to address concerns.