Many health systems around the world are introducing new care models which claim to replace expensive acute inpatient care with more primary and community-based services. This paper by Milliman consultants examines the primary care redesign of seven US practices over the course of three years, including their reported utilisation and savings achievements.
This article by Milliman consultants Eric Wunder and Brad Parker summarizes some key financial results for a composite of medical professional liability specialty writers through the second quarter of 2017. The decline in premium isn’t slowing down, and favorable reserve runoff from prior years is providing less financial relief. Future investment results look promising.
This article was originally published in the September 2017 issue of the Medical Liability Monitor.
More healthcare-related regulatory news for plan sponsors, including links to detailed information.
IRS issues guide on ACA information returns
The Internal Revenue Service (IRS) released Publication 5258, “Affordable Care Act (ACA) Information Returns (AIR) Submission Composition and Reference Guide.” The purpose of this document is to provide guidance to all types of external transmitters about composing and successfully transmitting compliant submissions to IRS.
To download the guide, click here.
IRS issues guide on electronic filing of ACA information returns
The IRS released Publication 5165, “Guide for Electronically Filing Affordable Care Act (ACA) Information Returns for Software Developers and Transmitters.” The guide outlines the communication procedures, transmission formats, business rules and validation procedures for information returns transmitted electronically through the AIR System.
To download the guide, click here.
If the Patient Protection & Affordable Care Act’s (ACA) cost-sharing reduction (CSR) subsidies were eliminated, it could expose insurance carriers to a substantial increase in selection risk related to their particular mix of business. In August, the Centers for Medicare and Medicaid Services (CMS) announced its intention to propose a set of risk adjustment modifications for states in which insurance carriers raise silver premiums in response to potential CSR subsidy termination.
In this paper, Milliman’s Jeffrey Milton-Hall, Doug Norris, and Jason Karcher explore the CMS proposal along with the current ACA risk adjustment program and three other potential alternative modifications to risk adjustment in response to the possible elimination of CSR funding.
Healthcare providers and health plans continue to integrate vertically through consolidation and virtually through accountable care organization (ACO) risk-sharing arrangements. In this article, Milliman’s Dave Liner discusses how providers and health plans can improve their financial performance by considering strategies that optimize regulatory capital.
The high cost of therapy for patients with chronic hepatitis C (HCV) infection has been an important topic of discussion for key stakeholders in pharmacy benefit design and management. Multiple effective treatments have been introduced, with cure rates approaching 100%.
Although costly, curing HCV early on can prevent serious liver complications, such as hepatic cirrhosis, organ failure, and cancer, for the approximately 2.7 million affected people in the United States.
In 2016, there was a downward cost and utilization trend for the HCV Specialty category. Express Scripts reported in its 2016 Drug Trend Report that utilization of HCV therapies had decreased by 27.3% and the unit cost had decreased by 6.7%. The cost per member per year (PMPY) for HCV drugs decreased to $25.26 from $38.44 PMPY the previous year.
Why have cost and utilization suddenly decreased after two years of steady growth?