- How is the English NHS prescription drugs budget spent?
By Joanne Buckle, Tanya Hayward, Ankush Aggarwal | 21 May 2019
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.
- Observations on the employer stop-loss market: 2019 survey
By Robert D. Bachler, Nicholas Johnson, Mike Hamachek | 16 May 2019
This paper summarizes the findings from Milliman’s 2019 stop-loss survey.
- Medical Payment Series: The rise of the DRG payment model
By Jiang Guanjun, Qiuwen Peng | 15 May 2019
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.
- Underwriting income continues to decline, with faint signs of a firming market on the horizon
By Susan J. Forray, Chad C. Karls | 13 May 2019
The medical professional liability industry’s long-term trend of declining frequency appears to have ended several years ago.
- No apparent workup for most new indeterminate pulmonary nodules in US commercially-insured patients
By Javier J.Zulueta, Bruce S. Pyenson, Carol Bazell, Michael J. Bellanich, Melissa A. Caplen | 13 May 2019
This article examines the pattern and cost of indeterminate pulmonary nodule workup in real-world practice using insurer administrative claims for commercially insured individuals.
- Medicaid adult dental reimbursement
By Joanne E. Fontana, Catherine E. Lewis, Tory Carver | 09 May 2019
This paper explores the relationships among a state’s adult Medicaid dental benefit, provider reimbursement, and dental care utilization rates.
- Critical Point Episode 11: Shea Anders talk blockchain (Part 3): Insurance applications
By Shea Parkes, Anders Larson | 08 May 2019
The third in a multi-part series, Milliman’s Shea Parkes and Anders Larson discuss potential insurance applications for blockchain technology, along with some of the drawbacks.
- Commercial health insurance: Detailed 2017 financial results and emerging 2018 trends
By Paul R. Houchens, Jason A. Clarkson, Jason Melek | 07 May 2019
This report provides a detailed review of the commercial health insurance industry’s financial results for 2017 and evaluates changes in the market’s expense structure and enrollment relative to prior years.
- Removal of safe harbor affects EGWPs
By Stephen Kaczmarek | 02 May 2019
A proposed rule from the Department of Health and Human Services would revise the safe harbor protection in Medicare Part D that currently allows pharmaceutical manufacturer rebates to be paid after the point-of-sale and start requiring such rebates to be credited against the drug’s point-of-sale price.
- Machine learning in healthcare
By Judith Houtepen, Sjors Altemuhl | 01 May 2019
With machine learning, the role of the actuary in the Dutch healthcare landscape becomes more crucial than ever.