Insight: Healthcare - Milliman

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Is direct-to-provider contracting a potential silver bullet for achieving value-based care for employer-sponsored plans?
By Andrew Timcheck, Cory Gusland, Mike Gaal | 19 July 2019

The interest that providers and employers have expressed for direct-to-provider solutions is complicated by the numerous ways these arrangements can be structured.
Emerging risks in insurance: Antibiotic resistance
By Tanya Hayward, Emma Hutchinson | 18 July 2019

In the context of antibiotic resistance, de-linkage of profit and volume through the use of an insurance model has been proposed as a potential strategy to stimulate innovation and curb antibiotic resistance through the availability of novel antibiotics.
Medicare Supplement: Climbing a slippery slope?
By Kenneth L. Clark | 17 July 2019

What are the theoretical actuarial considerations and areas of opportunity in the Medicare Supplement business?
How blockchain technology will disrupt the PBM-payer-pharmacy relationship
By Brian N. Anderson, Gregory Callahan, Michael DiPrima | 11 July 2019

This article describes the origin of pharmacy benefit managers (PBMs), how claims are processed, and ways in which blockchain could disrupt the PBM marketplace.
Use of generalised linear modelling in Indian insurance market for pricing health products
By Joanne Buckle, Ankush Aggarwal, Pravin Harodia | 08 July 2019

What are the current and potential uses of generalised linear modelling in the Indian health market?
Medicaid managed care financial results for 2018
By Jeremy D. Palmer, Christopher T. Pettit, Ian M. McCulla | 28 June 2019

This report summarizes the calendar year 2018 experience for selected metrics of organizations reporting Medicaid experience under the Title XIX Medicaid line of business on the National Association of Insurance Commissioners annual statement.
The real-world Medicare costs of Alzheimer disease: Considerations for policy and care
By Bruce S. Pyenson, Charles Steffens | 28 June 2019

This article compares total Medicare-covered (allowed) costs of patients with Alzheimer disease with the risk-adjusted costs of beneficiaries without dementia over their last years of life, using claims data.
Medicare Advantage enrollment: Growth expectations for new organizations
By Kelly S. Backes, Julia M. Friedman | 26 June 2019

This paper analyzes historical enrollment experience for parent organizations new to the Medicare Advantage market from 2007 to 2018.
Critical Point Episode 14: Climate change, immigration, and opioids: The effect of global events on mortality
By Dale S. Hagstrom | 24 June 2019

Global events like climate change, immigration, and opioids have the potential to affect mortality rates, as Milliman consulting actuary Dale Hagstrom discusses in the latest episode of the firm’s podcast, Critical Point.
Emerging risks and opportunities in insurance: Technology and innovation
By George Barrett | 17 June 2019

This paper describes how innovation can lead to risks for insurance companies and gives insight on how to stay one step ahead.

See More Articles

06 June 2019
New CMS guidance for Medicaid managed care medical loss ratio calculations
The May 15, 2019, Informational Bulletin from the Centers for Medicare and Medicaid Services focuses on the responsibilities of a subcontractor in providing data and the proper accounting of subcontractor payments for purposes of medical loss ratio reporting.
03 June 2019
Financial sustainability of an integrated medical-behavioral primary care practice
The state of Colorado has implemented behavioral healthcare in primary medical care settings under a Centers for Medicare and Medicaid Services State Innovation Model Award.
31 May 2019
Health plan participation in the employer stop-loss market
While there can be hurdles for a health plan to overcome when trying to enter the employer stop-loss market or grow an existing stop-loss block, the market can provide meaningful opportunities.
23 May 2019
Model change impact on the Medicare Advantage 2020 RxHCC risk scores
This paper summarizes the changes in member risk scores resulting from the revised Medicare Part D risk score model for payment year 2020.
23 May 2019
Opioid use disorder: Costs, utilization, and comorbidities
Many patients with opioid use disorder have complex healthcare needs, contributing to their significant healthcare costs.
21 May 2019
How is the English NHS prescription drugs budget spent?
This paper provides a snapshot of the general practitioner prescription cost and activity as well as driving trends for financial year (FY) 2016/17 and FY 2017/18 in England.
16 May 2019
Observations on the employer stop-loss market: 2019 survey
This paper summarizes the findings from Milliman’s 2019 stop-loss survey.
15 May 2019
Medical Payment Series: The rise of the DRG payment model
This article investigates the transition from the currently mainstream fee-for-service model to the diagnosis-related group (DRG) payment model, the history of DRG in foreign markets, and the potential challenges to having a DRG payment model in China’s system.