Healthcare costs

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

By Laurie Lingefelt  |  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.

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.

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.

By David Stoddard  |  13 February 2018

Trustees and administrators should keep a number of topics in mind when planning for 2018 and beyond.

By Stephen P. Melek, Doug Norris, Katie Matthews, Ally Weaver, Stoddard Davenport  |  12 February 2018

This report uses healthcare cost and utilization data to project spending estimates for people with chronic medical and comorbid behavioral conditions in 2017.

02 February 2018

Amazon, Berkshire Hathaway, and JPMorgan Chase bring a fascinating variety of perspectives to the challenges of healthcare.

By Joanne Buckle, Tanya Hayward  |  15 January 2018

This paper presents a case study to discuss the process and considerations for developing an accountable care system in a regional National Health Service system.

By Lalit Baveja, Mason Roberts  |  10 January 2018

The literature shows that a disease management programme is not a guarantee of cost savings, but in addition to community health improvements and improved clinical outcomes, desired cost savings can be realised if the programme is designed correctly.

By Stephanie Peterson, Shyam Kolli, Marcella Giorgou, Elaine Britt  |  10 January 2018

Health and group benefits news and developments in the United States.

By Pamela M. Pelizzari, Jocelyn Lau, Harsha Mirchandani  |  08 January 2018

This paper combines data from the report of Performance Year 1 (PY1) results and other publically available sources to compare hospitals that received payments in the Comprehensive Care for Joint Replacement model PY1 to those that did not.