- Is your provider organization maximizing its performance in value-based care programs?
By Rod Martin, 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.
- Insurance risk and its impact on provider shared risk payment models
By Juliet M. Spector, Cory Gusland, Carol Kim | 12 January 2018
A challenge facing providers and payers is to design shared risk payment models that incentivize providers to deliver efficient, high-quality care without assuming too much insurance risk from payers.
- ACA risk adjustment management: Going all-out
By Brandy N. Millen, Jason Petroske | 22 December 2017
This paper introduces the broader concept of risk management adjustment and highlights actions you can take to maintain its long-term success.
- Risk adjustment in CMS episode-based payment models: A resource guide
By Samuel Bennett, Thomas D. Snook | 20 December 2017
This paper provides a high-level guide on risk adjustment within the broader scope of four Centers for Medicare and Medicaid Services episode-based payment models.
- 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.
- Provider coding accuracy in commercial value-based contracts
By Jared Hirsch, Howard Kahn, Rong Yi | 02 October 2017
This paper explores various aspects of risk sharing as it pertains to value-based contracting for commercial lines of business.
- Regulatory capital strategies in an evolving health insurance landscape
By David M. Liner | 30 August 2017
As the relationship between health plans and healthcare providers continues to evolve, this landscape creates new financial opportunities for health plans managing regulatory capital.
- 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.
- How capitation arrangements can be applied to deliver the NHS Sustainability and Transformation Plans
By Tanya Hayward, Joanne Buckle | 16 May 2017
This paper explores how the principles of a traditional capitation arrangement may apply in a regional National Health Service system where the stakeholder roles differ and the implementation of various key capitation principles is not possible.
- Administrative benchmarks for health insurance in India
By Lalit Baveja | 25 April 2017
Milliman can help clients improve their administrative performance by conducting company function-by-function comparisons of administrative performance and staffing levels versus competitors and peers, and recommending appropriate process improvement initiatives.