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Objectivity matters. Today, more than ever.

Independent for over 70 years, Milliman delivers market-leading services and solutions to clients worldwide. With no agenda, other than getting it right.

Through a team of professionals ranging from actuaries to clinicians, technology specialists to plan administrators, we offer unparalleled expertise in employee benefits, investment consulting, healthcare, life insurance and financial services, and property and casualty insurance.

News

  • 19 February 2019 — Captive Review
    The 2018 Captive Review Power 50
  • 14 September 2018 — Wall Street Journal
    Florence flood threat heightened by underinsured homeowners
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Long-term care consulting

We offer unmatched depth and breadth of knowledge in long-term care.

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Expanding access to quality healthcare for a California community.

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Recent stories

  • Amendments to IFRS 17 from February 2019 IASB Meeting
  • An end to manufacturer rebates as we know them today?
  • Year-End 2018 Actuarial Function: What's new
  • Pathways to Success MSSP final rule: Winners and losers
Solvency II

Recalculation of the Transitional Measure on Technical Provisions

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MACRA
MACRA: The series
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Medicare Part D member profitability by pharmacy channel
Medicare Part D member profitability by pharmacy channel

Medicare

  • The Medicare Advantage Value-Based Insurance Design Model: Overview and considerations

    By Catherine M. Murphy-Barron, Pamela M. Pelizzari, Brian Regan | 19 February 2019

    This research brief describes the Value-Based Insurance Design model for Medicare Advantage organizations (MAOs) and explores key considerations for eligible MAOs considering participation in the model.

  • An end to manufacturer rebates as we know them today?

    By Deana Bell, Jennifer Carioto, Matthew Hayes | 15 February 2019

    The proposed rule to make drug manufacturer rebates no longer protected under the Anti-Kickback Statute has broad impacts to federally funded prescription drug programs, especially Medicare Part D.

  • Pathways to Success MSSP final rule: Winners and losers

    By Anders Larson, Cory Gusland | 14 February 2019

    This paper examines the Medicare Shared Savings Program’s (MSSP) final rule from the perspective of different accountable care organization (ACO) situations to help readers understand how the MSSP rule might affect different ACOs.

  • LTSS services in Medicare Advantage Plans

    By Pedro Alcocer, Robert Eaton, Pamela Laboy | 12 February 2019

    This article addresses how the Medicare Advantage marketplace responded in 2019 to the Centers for Medicare and Medicaid Services’s expanded definition of primarily health-related benefits, including which supplemental benefits plans are offering and where these benefits are offered.

  • Including dementia in the Part C Medicare risk adjuster: Health services issues

    By Bruce S. Pyenson, Charles Steffens | 11 February 2019

    The Centers for Medicare and Medicaid Services released its proposed 2020 risk score methodology for Medicare Advantage plans in December, and it describes proposed updates to the existing Hierarchical Condition Category (HCC) risk adjustment model and suggests an alternative model, which includes two HCCs for dementia.

  • Changing the rebate game: A primer on the HHS proposed rule to shift drug rebates to POS

    By Maggie Alston, Carol Bazell, David R. Mike | 08 February 2019

    This paper discusses the implications of recently proposed rebate regulation to various Medicare Part D program stakeholders.

  • Seven key challenges for Medicaid states considering alternative payment models

    By Anders Larson, Rebecca L. Johnson, Zach Hunt | 29 January 2019

    This article focuses on some of the challenges that Medicaid payers (including states and managed care organizations) face when trying to establish alternative payment models with providers.

  • Pathways to Success MSSP final rule: Key revisions to the proposed rule

    By Noah Champagne, Charlie Mills, Jason Karcher | 07 January 2019

    This paper summarizes the key provisions of the final rule for the 2019 Medicare Shared Savings Program and highlights differences from the Centers for Medicare and Medicaid Services’s August proposal.

  • Pathways to Success MSSP final rule: Faster movement to downside risk increases focus on reducing population costs

    By Kathryn V. Fitch, Adam Laurin, Michele M. Berrios | 04 January 2019

    Under the new Medicare Shared Savings Program’s new rule, there will be a more urgent need for accountable care organizations to reduce population costs.

  • Proposed updates to actuarial soundness: Creating flexibility and strengthening the requirements

    By Brad Armstrong, Marlene Howard, Christopher T. Pettit | 03 January 2019

    The Centers for Medicare and Medicaid Services released proposed updates to Medicaid managed care regulations with the goal of easing some of the regulatory burdens while increasing the requirement for transparency.

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  • 06 December 2018

    Proposed updates to pass-through payment guidance

    The updates to Medicaid managed care pass-through payment guidance promulgated in 42 CFR 438.6 appear to simplify and streamline the approval process.

  • 03 December 2018

    Proposed reforms to Part B Rx for the Medicare Fee-for-Service program

    This paper outlines proposals to shift certain drugs from Part B to Part D and to change Medicare’s system for administering Part B drugs.

  • 16 November 2018

    Dental coverage in Medicare Advantage Plans: Nationwide market landscape

    Dental services aren’t included in standard Medicare benefits, leaving seniors and other Medicare recipients with a dental coverage gap.

  • 01 November 2018

    Pathways to Success: MSSP proposed rule: Integrity

    This paper discusses ways in which accountable care organizations have been identified by the Centers for Medicare and Medicaid Services (CMS) as weakening integrity and how CMS is proposing to address concerns.

  • 19 October 2018

    Pathways to Success: MSSP proposed rule: Assignment changes to identification of E&M Services in skilled nursing facilities

    This paper discusses the current and proposed rules related to evaluation and management services in the Medicare Shared Savings Program.

  • 17 October 2018

    2019 cost-of-living adjustments for Medicare benefits

    CAB 18-3: The Department of Health and Human Services’ Centers for Medicare and Medicaid Services has announced cost-of-living adjusted figures for Medicare Part A and Part B for 2019.

  • 16 October 2018

    Population-based payments (PBPs) open door for ACOs to more effectively manage care

    The Next Generation accountable care organization (ACO) model introduced a provider payment mechanism called population-based payments that allow ACOs to negotiate provider payment rates and may allow more effective management of resource use.

  • 15 October 2018

    Impact of Next Generation ACO Model on Medicare spending in 2016

    This paper combines the aggregate gross impact of each of the Next Generation Accountable Care Organizations (NGACOs) shown in the NORC report with the shared savings/(loss) results of each NGACO to calculate the net impact of each individual NGACO.

Healthcare

  • Affordable Care Act research
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  • Healthcare reform reading list: From the ACA archives
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  • Medicare ACOs and Alternative Payment Models
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See all topics
  1. Healthcare
  2. Affordable Care Act research
  3. Healthcare costs
  4. Healthcare reform 2.0
  5. Healthcare reform reading list: From the ACA archives
  6. Long-term care insurance
  7. Medicaid
  8. Medical professional liability
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  10. Medicare ACOs and Alternative Payment Models
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  19. Insurtech
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  • Featured videos

    • Medicare Advantage (Thumbnail)Understanding healthcare costs: Medicare Advantage(4:00)
    • Medicaid - ThumbnailUnderstanding healthcare costs: Medicaid(4:44)
    • Opportunities in Healthcare Reform - ThumbnailOpportunities in healthcare reform(1:51)
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For more than seven decades, Milliman has combined technical expertise with business acumen to create elegant solutions for our clients. 

Today, we are helping companies take on some of the world's most critical and complex issues, including retirement funding and healthcare financing, risk management and regulatory compliance, data analytics and business transformation.


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