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Healthcare Cost Modeling

Milliman Health Trend Guidelines

Milliman Health Trend Guidelines™ (HTG) give insurers, healthcare providers, and employers monthly information on healthcare expenditures and utilization for individuals enrolled in commercial insurance plans in the United States. The Trend Guidelines are updated with 12-month trailing data each month, serving as a vital tool and benchmark for negotiations for plan renewals, the setting of trend guarantees, forecasting, premium rate development, and many other applications.

The HTGs are a series of indices providing data on the cost, utilization, and unit costs of healthcare services - both in total and broken down separately for professional services, inpatient and outpatient services, and brand and generic prescription pharmaceuticals.

These guidelines are the main source for subscribers to get an independent, data-driven read on the pulse of what’s happening with healthcare in the U.S. Our guidelines incorporate real data points—based on experience data —leading to a more accurate overall picture of the trajectory of the healthcare system in this country. The information used to calculate the indices is provided by leading health insurance plans and data firms, covering approximately 60 million insured covered individuals in the U.S., representing about 40 % of the total commercially enrolled private fee-for-service market.

The costs covered by the HTGs are based on the allowed amounts accepted by each healthcare provider - doctor, hospital, outpatient test center, or pharmacy. The indices are calculated along four lines of business:

  • Large fully insured employer group plans
  • Small fully insured employer group plans
  • Individual plans
  • Administrative Services Only employer group plans

Indices are calculated at the national level. Regional (all market segments), and state and metropolitan area (Large Group and ASO) indices are available. Indices can also be customized to reflect a clients’ unique geographical population mix. Custom indices are also available.

The HTGs provide a high level of data on direction of healthcare costs with minimal time lag since the date of service. The comprehensiveness of the indices yield critical benchmarks to trends in specific keys markets as well as for the country as a whole. This gives insurance plans, employers, and providers the information they need to make defensible decisions in negotiations and price setting.

To learn more about the HTGs, please see our brochure.

For more information about the HTGs, please contact the Milliman Health Cost Guidelines manager at [email protected].


Milliman Health Trend Guidelines resources

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