Hospital professional liability database: Key findings

In 2010, Milliman created a hospital professional liability database. This includes professional liability for hospitals, nursing homes, and long-term care facilities using data gathered from our offices throughout the country. In this paper, Milliman consultants provide an updated analysis of key findings from our hospital professional liability database.

What should employers consider when life and disability benefits renewal time comes around?

The overall spending on life and disability benefits is significantly less than the costs for healthcare coverage. But a little focus there can often lead to real savings on these products along with greater employee satisfaction.

Benefits managers don’t have to wait until a renewal at the end of a rate guarantee to review the program’s experience. Performing reviews on an annual basis can ensure that there are no surprises.

Benefits managers should consider rate comparisons, quality of service received, and integrated leave management options as well as disability and life insurance specific considerations.

In this article, Milliman’s Jennifer Fleck discusses in more detail what employers should consider when group disability and life insurance benefits come up for renewal.

Healthcare Trend Guidelines transitioning from S&P to Milliman

Milliman today announced the transition of the industry’s leading healthcare cost trend indices from S&P/Dow Jones to Milliman. Since 2013, Milliman has co-developed these indices in conjunction with S&P and Health Index Advisors Inc. (HIA), a joint venture in which Milliman was a 50% shareholder. Upon transition, the indices will be re-branded to the Milliman Health Trend Guidelines. With the Health Trend Guidelines now returning to Milliman, clients will have the benefit of combining Milliman’s expertise with the best health cost trend tool available. These Guidelines are built on a database of approximately 60 million commercially-insured lives, representing about 40% of the total U.S. fee-for-service health insurance market.

“The Milliman Health Trend Guidelines offer a better lens for deciphering healthcare costs, both present and future,” said Lorraine Mayne, Milliman Global Health Practice Director. “Not only can we now offer our clients the most up-to-date trend information, but we can pair that data with our actuarial, machine learning, and deep subject matter expertise to produce robust forecasts of potential future trends. No other healthcare firm has the ability to look both so deeply and so far ahead.”

The Health Trend Guidelines will be released on a monthly basis with supplemental research from Milliman consultants. Organizations interested in accessing Milliman’s healthcare trend research should contact [email protected]

“The Milliman Health Trend Guidelines support several important use cases,” said Scott Harris of Milliman. ”Many health plans use them for renewal negotiations and forecasting, providing an independent source of truth for parties looking to minimize the uncertainty of healthcare cost inflation. Milliman is the leading advisor to healthcare payers, and the acquisition of the Health Trend Guidelines further complements the scope of Milliman healthcare intelligence available to insurers, ACOs, unions, and self-insured employer groups, many of whom use them as a settlement vehicle for trend guarantees. The Guidelines are also an essential tool for the financial services industry, which uses them as a tool in predicting overall healthcare cost trends and their impact.”

For more information about the Milliman Health Trend Guidelines, click here.

New MSSP rule highlights urgency for ACOs to reduce population costs

On December 31, 2018, the Centers for Medicare and Medicaid Services (CMS) released a sweeping new rule that will significantly change the Medicare Shared Savings Program (MSSP).

One of the hallmarks of the new MSSP rule is faster movement to downside risk. Under the current regulations, accountable care organizations (ACOs) can stay in an upside-only track for up to six years. The new rule requires some ACOs in the Basic Track to begin assuming some downside risk in year 3 (low revenue ACOs new to MSSP and inexperienced with risk can remain in an upside only arrangement until Year 4) and those in the Enhanced Track assume downside risk in year 1. To date, ACOs in Track 1 have had a longer trajectory for assuming downside risk and may not have experienced the same pressure to reduce costs as ACOs participating in MSSP tracks with downside risk.

Under the new rule, there will be a more urgent need for ACOs to reduce population costs in order to mitigate losses. Identification and reduction of medically unnecessary services should be considered as a strategy to reduce population costs.

In this article, Milliman’s Kate Fitch, Adam Laurin, and Michele Berrios discuss data mining tactics that identify medically unnecessary services. They share several approaches they have seen successful ACOs adopt to effectively guide strategies to reduce medically unnecessary services and in turn reduce the ACO’s total population costs.

Critical Point focuses on diagnosing and predicting opioid use disorder

Opioid use disorder (OUD) affects all age groups across the United States. There are about 1.5 million commercially insured Americans with OUD, and there are also a significant number of people on the verge of being recognized as having the disorder. Opioid prescriptions seem to be stabilizing or dropping, but there is growth in synthetic opioids, which are starting to take off in many communities around the country. In this episode of Critical Point, Milliman’s Stoddard Davenport and Joseph Boschert discuss their latest research on opioid use in the U.S., including how advanced analytics can help predict whether a patient may develop OUD.

To listen to this episode of Critical Point, click here.

Proposed updates to actuarial soundness present new considerations

The Centers for Medicare and Medicaid Services (CMS) released proposed updates to Medicaid managed care regulations with the goal of easing some of the regulatory burdens while increasing the requirement for transparency. These updates offer more flexibility in developing and placing more regulation on certifying actuarially sound capitation rates.

The most significant changes related to actuarial soundness under the proposed authority are the reintroduction of certifying rate ranges and the considerations that must be given to assumptions applicable to rates under different federal financial participation levels.

The reversal of the elimination of rate ranges from the 2016 final rule places more stringent requirements on documenting support for the developed rate ranges. CMS also commented that the reintroduction of rate ranges may be especially valuable to states that procure contracts through competitive bidding, which was a primary reason for installing them.

To read more about the proposed updates to actuarial soundness, read this article by Brad Armstrong, Marlene Howard, and Christopher Pettit.