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Milliman provider insight

29 December 2022 - By Eugene Chang, John Kasey

This paper outlines one category of health plan expenses—administrative costs—that are controllable because they’re driven by business decisions such as staffing, technology, and operational processes.

16 February 2022 - By Marcella Giorgou

We provide plan sponsors the latest information regarding the coverage requirements for OTC COVID-19 tests, based on recent FAQs issued by federal agencies.

22 December 2021 - By Kevin Pierce, Jake K. Klaisner, Alex Cires

The proposed changes to Medicare Part D as part of the Build Back Better Act would affect all parties involved with the program.

22 December 2021 - By Jake K. Klaisner, Kevin Pierce, Alex Cires

If the Build Back Better Act eventually passes the Senate in some form in 2022, it could potentially bring the largest changes to U.S. drug pricing in the history of Medicare

17 December 2021 - By Jason Karcher, Andrew Bourg

Besides providers, the action affects health plans such as Medicare Advantage organizations and Part D plan sponsors, plus insurers, employers, and patients.

10 December 2021 - By Chris Smith, Joseph Boschert, Mike Gaal, David C. Lewis

The hospital price transparency rule introduces new opportunities and competitive threats in the U.S. healthcare system.

05 April 2021 - By Austin Barrington, Joseph Boschert, Mike Gaal, David C. Lewis

Early days of hospital price transparency: two-thirds of providers have posted key metrics.

05 April 2021 - By Penny Edlund, Anikia Nelson, Melody Craff, Maureen Tressel Lewis

Our study of racial disparities in cardiovascular disease contributes new research and approaches toward achieving healthcare equity.

17 March 2021 - By Josh Reinstein, Phil Ellenberg

Hospital price transparency: The impact of the shoppable file.

17 February 2021 - By David G. Hayes, Courtney R. White

This paper discusses how a provider-sponsored MCO and its parent health system can team together to create a unique player in the health insurance landscape, using major levers and how they can impact the success of each organization.

04 February 2021 - By Noah Champagne, Matthew Emery

To succeed in the Medicare Advantage (MA) space, provider-based MA plans face the challenge of providing affordable, efficient healthcare to Medicare beneficiaries without cutting into their own revenue flow.

22 January 2021 - By Matthew Emery, Howard Kahn, Devin McCall, William M. Sayre, Stuart Silverman

This paper introduces life insurance investment strategies and how many of these same concepts can be applied to healthcare insurers and providers to better manage their overall risk profiles and potentially increase future returns on investment.

03 November 2020 - By Smitha Radhakrishna

Digital health is expanding, and its power is especially relevant now during the COVID-19 pandemic.

10 September 2020 - By Susan Philip

The COVID-19 pandemic has dramatically increased the use of telehealth, so Milliman’s Susan Philip and Mei Kwong, executive director of the Center for Connected Health Policy, discuss what providers, payers, and patients should know about this virtual healthcare service.

01 July 2020 - By Kendall Carolissen, Judith Houtepen

This article describes the application of two methods for the detection of potential fraudulent claims in healthcare provider invoices.

19 May 2020 - By Cory Gusland, Anders Larson, Brian A. Sweatman

For any given provider organization, the impact of COVID-19 on its value-based contracts will depend largely on certain actuarial, legal, and strategic aspects of each agreement.

30 April 2020 - By Luke B.G. Roth , Ben Mori, James Pettersson, Joseph Whitley, Carol H. Steckel

While large for-profit healthcare provider entities with existing capital reserves or greater access to capital markets may be able to weather the financial strain caused by the COVID-19 pandemic, other small, rural, or safety net provider entities may require additional support to keep their doors open.

22 April 2020 - By Susan J. Forray, Stephen J. Koca

Modeling medical professional liability costs affected by the COVID-19 pandemic is exacerbated by tort law changes, variation in effect among specialties, and an apparent reduction in current claims that may prove to be only a delay contributing to an increase in future reported claim frequency.

03 April 2020 - By Courtney R. White

Providers are uniquely situated to both direct and/or provide care for those in the healthcare delivery system through establishing their own health plans or contracting with existing payers.

27 August 2019 - By Colleen Norris, Thomas D. Snook

While shared-risk contracts may be conceptually simple, the actual real-world financial adjudication of these contracts is usually complex.

01 October 2015 - By Juliet M. Spector, Brian H. Studebaker, Ethan Menges

This paper outlines the general steps and considerations for designing, implementing, and measuring results of existing payment reform models.

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