Milliman MedInsight’s analytic platform named a leader in IDC MarketScape report

May 20th, 2015

By Todd Fessler

Milliman today announced that its popular healthcare analytic platform, MedInsight, has been named a leader in the IDC MarketScape study, entitled “U.S. Payer Data Analytics 2015 Vendor Assessment, doc #HI255269, April 2015.” The company is one of eight vendors evaluated in the report.

MedInsight is positioned as a leader of this IDC MarketScape report—which provides an evaluation of the leading payer data analytic platforms—due to high satisfaction ratings from clients in terms of the high degree of flexibility, advanced analytics, and analytic tools supporting multiple types of users.

The report notes that Milliman’s strengths include the MedInsight Data Confidence Model—a methodology applied as a data warehouse is being created, and then leveraged on an ongoing basis for client data management—as well as the MedInsight benchmarking function that enables clients to benchmark organizational performance against Milliman’s health research database.

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“The MedInsight mission is to provide analytic leadership and decision confidence to our clients. The fast-moving and uncertain nature of the healthcare industry demands a nimble and growing analytic platform,” said Kent Sacia, Milliman Principal. “The IDC MarketScape report affirms the MedInsight team’s hard work toward that mission as we continuously commit to adding value to our clients.”

IDC MarketScape vendor analysis model is designed to provide an overview of the competitive fitness of ICT suppliers in a given market. The research methodology utilizes a rigorous scoring methodology based on both qualitative and quantitative criteria that results in a single graphical illustration of each vendor’s position within a given market. The Capabilities score measures vendor product, go-to-market and business execution in the short-term. The Strategy score measures alignment of vendor strategies with customer requirements in a 3-5-year timeframe. Vendor market share is represented by the size of the circles. Vendor year-over-year growth rate relative to the given market is indicated by a plus, neutral or minus next to the vendor name.

For more information about Milliman’s MedInsight products, click here.

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Healthcare costs climb to $24,671 for a typical American family in 2015

May 19th, 2015

By jeremy.engdahl-johnson

Milliman today released the 2015 Milliman Medical Index (MMI), which measures the cost of healthcare for a typical American family of four receiving coverage from an employer-sponsored preferred provider plan (PPO). In 2015, costs for this family will increase by 6.3% ($1,456), resulting in a total cost of $24,671. The employer pays $14,198 of this and the employee—through payroll deductions and cost sharing at the time of service—pays $10,473. Of this year’s total $1,456 increase, $467 was a result of prescription drugs, a 13.6% increase after a five-year period in which prescription drug costs averaged annual increases of 6.8%.


“For the last several years we’ve noted that the Milliman Medical Index was only indirectly affected by the Affordable Care Act, since the employer-sponsored insurance market was not a focus of the early reforms,” said Chris Girod, co-author of the Milliman Medical Index. “But now we have the prospect that this family’s health plan—which, in terms of actuarial value, is in a “gold” plan—may trigger the “Cadillac tax” that goes into effect on high-cost health plans in 2018. Whether or not our typical family of four finds themselves affected by the Cadillac tax will depend on whether future trends exceed recent levels, with people insured through smaller employer-sponsored plans potentially being more susceptible.”

This year’s 6.3% cost increase follows last year’s all-time low of 5.4%. Most of the components of care analyzed by the MMI (physician, outpatient, inpatient, other) experienced trends in line with recent years, but the sharp increase in prescription drug costs heightened the overall rate of increase.

“The rate at which prescription drug costs increased this year doubled over the average increase of the prior five years,” said Scott Weltz, co-author of the MMI. “This was driven by a combination of factors, including the introduction of new specialty drugs, a continued increase in compound drugs, and price increases for both brand name and generic drugs.”


“Healthcare costs for this family have doubled in the past decade, and tripled since we began tracking this information in 2001,” said Sue Hart, co-author of the MMI. “As has been the case throughout the time we have studied costs for this family, the rate of increases far outpace the consumer price index.”

Employees and employers have shared the burden of this cost increase. The MMI is somewhat unique among health cost studies because it measures the total cost of health care services used by the family of four, including out-of-pocket expenses paid at time of service, and it separates the costs into portions paid by employer versus employee. For the fifth consecutive year, employees have assumed an increasing percentage of the total cost of care.


To view the complete MMI, go to

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Milliman Medical Index coming next week

May 15th, 2015

By jeremy.engdahl-johnson

Milliman will release its 2015 Milliman Medical Index (MMI) on Tuesday, May 19 at 11:00 AM Eastern. The MMI measures the cost of healthcare for a typical American family of four receiving coverage from an employer-sponsored preferred provider plan (PPO). The MMI is unique because it examines not only the costs paid by the employer, but also the costs assumed by employees.

Check in on Tuesday to find out how much healthcare costs have increased for this family. Last year those costs reached $23,215.

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ACA implications for home and community-based services

May 15th, 2015

By Javier Sanabria

The Patient Protection and Affordable Care Act (ACA) modifies Section 1915(i) of the Social Security Act to help states expand home and community-based services (HCBS) through Medicaid. States exploring this option need to understand the financial implications related to the implementation of Section 1915(i).

Milliman’s Rob Damler and Marlene Howard discuss several features and considerations of the 1915(i) state plan option in their Contingencies article entitled “Medicaid and the ACA.” Here is an excerpt:

One of the most significant modifications to Section 1915(i) was the addition of Section 1915(i)(7), which allowed states to define target populations for the delivery of the HCBS benefit package. This section waives the comparability requirement established in the DRA version of Section 1915(i). The CMS final rule proposed that the parameters for the target populations be defined by “diagnosis, disability, Medicaid eligibility groups, and/or age.”

The waiver of the comparability requirement allowed states to do the following:

• Define multiple target populations for 1915(i) and tailor multiple HCBS packages that could be individually allocated to each population; and
• Vary the amount, duration, and scope of a single 1915(i) service between various target populations.

…The ACA also expanded eligibility for the 1915(i) state plan option to individuals with incomes up to 300 percent of the Supplemental Security Income Federal Benefit Rate. If states choose to use this income eligibility definition for a 1915(i) service package, individuals must meet an institutional level of care as well as the needs-based criteria defined by the state. If states maintain the income eligibility threshold of 150 percent of FPL as established by the DRA, individuals do not have to meet an institutional level of care.

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The ACA Cadillac tax: A primer for employers

May 13th, 2015

By Javier Sanabria

The excise tax on high-cost insurance plans is a narrowly targeted source of funding that the Congressional Budget Office has projected to be a significant source of revenue. The calculations involved in projecting the future burden of the Cadillac tax are complex and will become a necessary part of human resources benefit planning, union negotiations, and other postemployment benefit (OPEB) valuations. Milliman consultants Rob Pipich and Chris Ruff provide some perspective in this article.

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Regulatory roundup

May 11th, 2015

By Employee Benefit Research Group

More healthcare-related regulatory news for plan sponsors, including links to detailed information.

IRS releases 2016 inflation-adjusted amounts for health savings accounts
The Internal Revenue Service (IRS) has issued 2016 inflation-adjusted amounts for health savings accounts (HSAs). Revenue Procedure 2015-30 indicates that:

• Annual contribution limitation: For calendar year 2016, the annual limitation on deductions under Section 223(b)(2)(A) for an individual with self-only coverage under a high deductible health plan is $3,350. For calendar year 2016, the annual limitation on deductions under Section 223(b)(2)(B) for an individual with family coverage under a high deductible health plan is $6,750.

• High deductible health plan: For calendar year 2016, a ‘high deductible health plan’ is defined under Section 223(c)(2)(A) as a health plan with an annual deductible that is not less than $1,300 for self-only coverage or $2,600 for family coverage, and the annual out-of-pocket expenses (deductibles, co-payments, and other amounts, but not premiums) do not exceed $6,550 for self-only coverage or $13,100 for family coverage.”

For more information, click here.

Assessment of IRS compliance preparations
The Treasury Inspector General for Tax Administration (TIGTA) issued a new report evaluating the status of the IRS’s preparations for determining whether taxpayers maintained minimum essential coverage or met exemption requirements. The report also reviews the IRS’s preparation for assessing the shared responsibility payment during the 2015 filing season.

To read the entire report, click here.

IRS chief counsel issues memorandum regarding computation of medical loss ratio
The IRS Chief Counsel released a new memorandum regarding the computation of medical loss under Section 833(c)(5). To read the entire memo, click here.


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HR fatigue in relation to the ACA

May 8th, 2015

By Mikel Gray

Gray-MikelWhile the human resources (HR) community continues to adapt to changes caused by the implementation of the Patient Protection and Affordable Care Act (ACA), we wonder if HR professionals are experiencing job fatigue in relation to ever-increasing responsibilities created as a result of the ACA? Here are just two of the many additional responsibilities facing HR professionals post-ACA:

• HR professionals are tasked with additional reporting requirements under the ACA, including Section 6056 Reporting for applicable large employers to demonstrate they have met their shared responsibilities by providing affordable coverage, as well as 6055 Reporting (required starting in 2016) to provide documentation about which employees and dependents are covered by minimum value coverage month by month.
• HR professionals are seeing increased scrutiny from management as benefit budgets expand, which is due to the high and rising cost of coverage, potentially compounded by excise tax implications. These costs are gaining exposure at the top levels of organizations. More and more, HR departments are being asked, “What are we doing to control these costs?” That can be a difficult question to answer in meetings that demand encapsulated answers.

As a result, HR professionals are being asked more and more to take the lead in considering plan design changes and technology improvements to gain efficiencies and appeal to younger employees, but only when compared with the cost and feasibility of successful implementation. Finding a solution to these issues can be an exhausting process, especially for those HR professionals who have traditionally concentrated much of their efforts on other areas of the business.

We will be writing two follow-up blogs regarding what employers can do to solve the fatigue. The first will be on outsourcing, and the second will be on private exchanges. Stay tuned.

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Milliman MedInsight releases employer group reporting solution for health plans

May 5th, 2015

By Brian Studebaker

Milliman has announced the formal launch of their new MedInsight Employer Group Reporting (EGR) Solution. The MedInsight EGR Solution is designed for health plans to support the key function of client reporting; helping a health plan’s employer clients accurately understand the value they receive from their benefit spend and also providing a realistic performance comparison with other employers in the region.

MedInsight is Milliman’s popular healthcare analytic platform used by over 250 health plans, employers, at-risk providers/ACOs, state governments, community health coalitions, and third party administrators (TPAs).

The MedInsight EGR Solution delivers clients the benefits of confidence and control, while reducing the time and energy required to achieve them. As an extension of the MedInsight Analytic Platform and a beneficiary of our MedInsight Data Confidence Model, health plans and TPAs can feel confident that the information they are providing is accurate and meaningful, even as it’s made available to employer clients through a self-service portal.

Milliman expects many of its existing commercial health plan licensees of MedInsight to add the EGR Solution to bolster client reporting capabilities.

With user-friendly dashboards, a preconfigured reporting library, and easy-to-publish summary performance reports, the MedInsight EGR Solution helps health plans satisfy employer reporting needs easily and confidently.

“The employer clients of health plans are demanding more transparency on the value of healthcare being provided to their employees,” said Rich Moyer, Milliman principal. “We believe the MedInsight EGR Solution will be a very effective tool for health plans to deliver healthcare information to their employer clients. The EGR portal is easy to use and integrated with the health plan portal MedInsight clients currently use.”

Specifically, the MedInsight EGR Solution helps health plans and TPAs demonstrate the value they provide, by reporting on data that will help employers make decisions related to:

• Managing current and future cost trends
• Quality of healthcare services provided to employees
• Wellness programs and population health management

The ability to effectively meet employer clients’ ever-increasing demand for information and transparency comes with competitive benefits for MedInsight clients. It strengthens relationships with employers and provides the meaningful information actually required to bend cost trends and improve health. And by including innovative features like the Health Waste Calculator and population health groupers, MedInsight is providing them with value-add that extends to their employer clients.

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Regulatory roundup

May 4th, 2015

By Employee Benefit Research Group

More healthcare-related regulatory news for plan sponsors, including links to detailed information.

IRS releases guidance for filing ACA electronic returns
The IRS has released Draft Publication 5165 for software developers and transmitters. The guide outlines the communication procedures, transmission formats and other rules for returns filed electronically through the Patient Protection and Affordable Care Act (ACA) information returns system. The guidelines should be used to develop software for use with the system.

The procedures in the draft publication should be used when the following information returns are transmitted electronically:

• Form 1094-B, Transmittal of Health Coverage Information Returns
• Form 1095-B, Health Coverage
• Form 1094-C, Transmittal of Employer-Provided Health Insurance Offer and Coverage Information Returns
• Form 1095-C, Employer-Provided Health Insurance Offer and Coverage

IRS will provide a final Publication 5165 at a later date. To read the entire draft publication, click here.

TIGTA issues report on $3.3M in unpaid health insurance fees
The Treasury Inspector General for Tax Administration (TIGTA) released a report which found that health insurance providers and self-insured health plan sponsors failed to pay about $3.3 million in PCOR fees (not including applicable penalties and interest) tied to the ACA, a compliance problem that could be fixed by accessing more data about plan providers. TIGTA warned that if these potential non-filers are not notified, the pattern of not reporting and paying their PCOR fees could continue into future tax years.

To read the entire report, click here.

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Shorter LTC coverage period can reduce policy cost

April 27th, 2015

By Javier Sanabria

This Kiplinger article offers several issues that long-term care (LTC) buyers should consider to purchase a cost-effective policy. The article quotes Milliman’s Dawn Helwig discussing the benefit of purchasing a policy with reduced coverage periods.

Here’s an excerpt:

Once you’ve considered the type of risk you’d like to cover, ask yourself, “how much of that risk can you transfer to the insurance company, and how much can you tolerate on your own?” [Bonnie] Burns says. The first step is to choose a deductible, also known as the “elimination period,” which is the number of days between the time you become eligible for benefits and the time the insurer starts paying.

Many policies offer a 90-day elimination period, but prepare to spend $22,500 out of pocket for nursing-home care until benefits kick in. The longer your elimination period, the lower your premium will be. A 90-day elimination period costs about 40% less than a zero-day deductible, says James Glickman, president of LifeCare Assurance, a long-term-care reinsurer in Woodland Hills, Cal.

Choosing a shorter benefit period will also cut your cost. A benefit period of three to five years “will cover the vast majority” of long-term-care needs, says Dawn Helwig, a principal at actuarial and consulting firm Milliman. Consumers “shouldn’t feel like they have to buy the Cadillac policy,” she says.

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