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Can we use insurance-based reimbursement models for novel antibiotics?
By Joanne Buckle, Tanya Hayward | 05 September 2018
The lack of financial incentives associated with developing novel antibiotics has resulted in limited innovation in this area, though it is needed.
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International best practice benchmarks
By Joanne Buckle, Tanya Hayward | 05 September 2018
Milliman’s International Best Practice Benchmarks help quantify potentially avoidable admissions and beddays within a healthcare system to identify potential value opportunities.
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Pharma APMs: Can the industry learn to play well with others?
By Maggie Alston, Bruce S. Pyenson | 05 September 2018
The dynamics of alternative payment models suggest a potential win for insurers, pharmaceutical manufacturers, and patients through an emphasis on reducing cost and improving outcomes.
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The short-term/limited-duration insurance rule and the potential impact on health insurance markets
By Erik Huth, Jason Karcher | 31 August 2018
This brief analyzes the provisions of the final short-term/limited-duration insurance rule, the accompanying commentary, and the potential implications to individual insurance markets.
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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.
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Health and Group Benefits News and Developments, July 2018
By Christopher S. Girod, Susan K. Hart, Scott A. Weltz, Sean Silva | 26 July 2018
Health and group benefits news and developments in the United States.
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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.
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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.
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Don’t TrOOP off the cliff: True out-of-pocket amount poses challenges starting in 2020
By Todd M. Wanta | 20 June 2018
With significant changes to Medicare Part D from the Bipartisan Budget Act of 2018 and the Centers for Medicare and Medicaid Services Final Rule, one provision from the Patient Protection and Affordable Care Act that has gone largely unnoticed is the forthcoming TrOOP Cliff in 2020, for which plan sponsors should prepare.
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Critical Point podcast, Episode 1: Healthcare waste
By David P. Mirkin | 13 June 2018
Three members of our MedInsight team discuss minimizing healthcare waste and reducing unnecessary costs across the American healthcare system.
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A primer on prescription drug rebates: Insights into why rebates are a target for reducing prices
By Gabriela Dieguez, Maggie Alston, Samantha Tomicki | 21 May 2018
This article explains the finances associated with pharmaceutical manufacturer rebates and their impact on health insurer coverage decisions.
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2018 Milliman Medical Index
By Christopher S. Girod, Susan K. Hart, Scott A. Weltz | 21 May 2018
Healthcare costs for the typical American family of four rose to over $28,000 in 2018.
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How healthcare providers can reap the benefits of an actuarial mindset
By Lindsy Kotecki | 11 April 2018
Healthcare provider organizations can benefit in many ways from adopting actuarial approaches, which can help them improve financial security, strengthen leverage in negotiations, and advance clinical capabilities.
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Socioeconomics and morbidity: What can consumer data tell us about social risk factors?
By Ally Weaver | 22 March 2018
This paper explores relationships between lifestyle factors and morbidity that the authors encountered in their experience working with consumer and administrative claims data.
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Rising risk: Maximizing the odds for care management
22 March 2018
This analysis examines predictive models to determine if an enhanced model can better identify individuals with rising risk relative to traditional prospective risk adjustment models.
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Opioid use disorder in the United States: Diagnosed prevalence by payer, age, sex, and state
By Stoddard Davenport, Katie Matthews | 09 March 2018
Over 25 million American adults report suffering from daily chronic pain. The increasing use of opioids in recent years has taken a human toll, leading to a rising number of overdose deaths and diagnoses of opioid use disorder.
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Is your provider organization maximizing its performance in value-based care programs?
06 March 2018
As the use of value-based reimbursement programs and the associated financial impact increases, it is important for providers to be educated on the mechanics of the program and to understand the analytical, operational, and clinical requirements to ensure success.
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Genomic testing: Cost-savings or cost-inflating for payers
By Joanne Buckle | 02 March 2018
There is still some uncertainty regarding the future uptake of genomic testing and the levels of sophistication of new tests, and this article discusses some relevant considerations that can support a greater appreciation of the risks and gains to payers involved in funding these tests now.
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Complex/high-risk patient targeting case study
By Lalit Baveja, Tanya Hayward | 23 February 2018
This article discusses a clinic-based community intervention designed to improve access and quality of care for high-utilising, high-risk patients over the course of three years.
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Managing healthcare costs for 2018
By David Stoddard | 13 February 2018
Trustees and administrators should keep a number of topics in mind when planning for 2018 and beyond.