- Genetic disorders can no longer be excluded. What does that mean for insurers?
By Joanne Buckle, Neha Taneja | 16 August 2018
In India, the Delhi High Court’s decision in February 2018 to restrict insurance companies from rejecting genetic disorder claims has sparked worry among insurers.
- How will EDGE affect your 2019 ACA Risk Adjustment Transfer?
By Zachary M. Davis, Phil Ellenberg, Brian A. Sweatman | 02 August 2018
This paper and the accompanying interactive exhibits show the coefficients from the 2019 CMS HHS-HCC commercial risk adjustment model and compare how ACA experience from 2016 EDGE data incorporated into the 2019 model will affect risk scores, which have a direct impact on an issuer’s risk adjustment transfer.
- 2018 summary of individual market enrollment and Affordable Care Act subsidies
By Paul R. Houchens, Jason Clarkson, Zachary Fohl | 31 July 2018
A profile of the individual health insurance market for each state and the District of Columbia, summarizing insurer financials, marketplace enrollment, and federal assistance provided to households purchasing insurance coverage through the insurance marketplace, incorporating recently released data from the 2018 open enrollment period.
- The prevalence and payer costs of potentially avoidable emergent care visits for suspected amniotic membrane rupture in pregnant women
By Christine Ferro, Jocelyn Lau, Bruce S. Pyenson, Mona Kelkar | 30 July 2018
This article estimates the prevalence and payer cost of potentially avoidable visits to emergency care facilities, labor and delivery units or observation units for suspected cases of pre-labor rupture of amniotic membranes among pregnant women.
- 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.
- 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.
- Critical Point podcast, Episode 2: Alternative Payment Models 101
24 July 2018
A discussion about alternative payment methods, bundled payment, ACOs, and more.
- 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.
- 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.
- 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.