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EHB, MLR, and risk adjustment: Stakeholder considerations on the 2019 proposed Notice of Benefit and Payment Parameters
By Victoria Boyarsky, Rong Yi | 05 January 2018
This paper focuses on three proposed changes in the Notice of Benefit and Payment Parameters for 2019 that would likely affect premiums in the individual and small group markets.
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A risky prescription: Part D risk sharing arrangements
By Christopher Kunkel, Lynn F. Dong, Nicholas Johnson, Adam Barnhart | 04 January 2018
A discussion of some of the most important considerations for Medicare Advantage risk-sharing arrangements that include Part D coverage.
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Building a true picture of global health
28 December 2017
Facts relating to global health can be elusive. Even when they are known, they are rarely put to use in improving health outcomes. So what can be done to fix the problem?
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Addressing challenges in the transition to value-based care and alternative payment models: A case study in the Oncology Care Model
By Maggie Alston, Christine Ferro, L. Daniel Muldoon, Pamela M. Pelizzari | 11 December 2017
This paper highlights the key aspects of alternative payment model payment methodologies and uses the Centers for Medicare and Medicaid Services Oncology Care Model as a case study to illustrate these concepts.
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Impact of Mental Health Parity and Addiction Equity Act
By Stephen P. Melek, Daniel J. Perlman, Stoddard Davenport, Katie Matthews, Michael Mager | 22 November 2017
What has happened to utilization and costs for mental health and substance use disorder benefits as the mental health parity laws and associated rules were slowly rolled out?
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Can we be of service to the NHS?
By Joanne Buckle, Tanya Hayward | 25 October 2017
The authors discuss their recent experience in helping to develop an accountable care system within a sub-segment of the National Health Service encompassing a small number of clinical commissioning groups and local councils.
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Impacts of hurricanes on health outcomes and health insurance company operations
By Lynn F. Dong, Scott O. Jones, Michael J. Polakowski | 23 October 2017
From an operational and financial perspective, natural disasters can have significant effects on healthcare providers, insurers, and payers.
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Selling insurance across state lines: Intended and unintended consequences
By Susan Philip | 02 October 2017
Recent policy proposals may allow health insurance to be sold across state lines, and there are some critical intended and unintended consequences from this change.
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Prevalence, treatments and medical cost of multiple sclerosis in Japan based on analysis of a health insurance claims database
By Hiroyuki Ohta, Izumi Kawachi, Manami Yoshida, Mariko Sakamoto, Mieko Ogino, Shinzo Hiroi, Shuichi Okamoto, Kosuke Iwasaki | 26 September 2017
This article analyzes health insurance claims data to determine the current treatment status and medical cost of multiple sclerosis in Japan.
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Using prescription drug data for identifying missing diagnoses and for medical management in the Medicare Advantage market
By Corey Nathan Berger, Brooks Conway | 12 September 2017
Even though the Centers for Medicare and Medicaid Services does not use prescription data in assigning risk scores, Rx data can still be a valuable resource for Medicare Advantage plans.
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Health plan considerations for growing direct-to-consumer genetic testing
By Barbara Culley | 17 August 2017
This white paper looks at the progression of direct-to-consumer genetic testing and the current demand and growth, discusses industry concerns, and suggests activities for health plans to consider.
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2017 U.S. organ and tissue transplant cost estimates and discussion
By T. Scott Bentley, Steve Phillips | 03 August 2017
This report is Milliman’s triennial summary of estimated U.S. average costs per member per month, billed charges, and utilization related to the 30 days prior and 180 days after transplant admission for organ and tissue transplants.
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A valuable proposition: A look into the international private medical insurance market
By Joanne Buckle, Neha Taneja | 13 July 2017
A look at the current global market spread and size of the international private medical insurance (IPMI) market and discussion of some of the key considerations for pricing and experience rating a group IPMI policy.
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Genetic testing in England: ROI, cost-effectiveness analysis, or both to evaluate intervention
By Didier Serre, Joanne Buckle | 10 July 2017
The rapid uptake of genetic testing within the National Health Service (NHS) and current debate around genetics make evaluating tailored interventions increasingly more relevant to ensure an efficient use of NHS spend.
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2016 employer stop-loss market: A Milliman survey
05 July 2017
This survey analyzes the differences between health plan and third-party stop-loss carriers and covers product, underwriting, sales/distribution, plan performance, and various other factors.
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Introducing the SSIP: Provisions for market stabilization in the Better Care Reconciliation Act
By Thomas D. Murawski | 28 June 2017
This paper discusses elements of the State Stability and Innovation Program and outlines the details from the draft bill released on June 22.
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The old and the beautiful: How age and gender affect costs and premiums in commercial health care
By Doug Norris, Hans K. Leida, Erica Rode, Travis J. Gray | 08 June 2017
Age/gender rating is an area in which actuarial considerations are often in direct tension with social or public policy considerations.
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Reinsurance and high-risk pools: Past, present, and future role in the individual health insurance market
By Fritz Busch, Paul R. Houchens | 06 June 2017
This paper examines the historical uses of high-risk pools (HRPs) prior to the implementation of the Patient Protection and Affordable Care Act (ACA), the role of reinsurance under the ACA, the proposed usage of reinsurance and HRPs under the American Health Care Act, and considerations for states examining the creation and deployment of these types of mechanisms.
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2017 Milliman Medical Index
By Christopher S. Girod, Susan K. Hart, Scott A. Weltz | 16 May 2017
In 2017, the cost of healthcare for a typical American family of four covered by an average employer-sponsored preferred provider organization plan is $26,944, according to the Milliman Medical Index.
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Milliman RBRVS for Hospitals
By William J. Fox, Edward Jhu, Charlie Mills, Kevin Frodsham | 27 April 2017
The Milliman RBRVS for Hospitals™ Fee Schedule provides a simple solution for comparing hospital contractual allowed amounts, billed charge master levels, relative efficiency, and patient mix differences.