Healthcare costs

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?

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.

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.

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.

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.

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.

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.

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.

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.

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.

By Joy Qin  |  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.

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.

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.

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.

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.

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.

By Shyam Kolli  |  21 March 2017

This paper explores what price transparency means in the healthcare market, the forces driving the need for price transparency, challenges and uses of price transparency, and potential ways in which transparency can be improved for the benefit of consumers and also to be more effective in reducing overall healthcare costs.

By Steven P. May, Bill J. Thompson  |  20 March 2017

This paper highlights several elements of the American Health Care Act that affect the employer-sponsored insurance programs of large self-insured employers.

By Rebekah D. Bayram, Barbara Dewey  |  17 March 2017

The fate of essential health benefits (EHBs) is uncertain, and what could happen to them is an open question.

By Lynn F. Dong  |  13 February 2017

A discussion of recent trends, potential benefits, and considerations for providers and payers considering joint venture health plans.