Category Archives: Reform

How may reinsurance and high-risk pools affect the individual market?

Milliman’s Paul Houchens and Fritz Busch will speak at this year’s National Conference on the Individual and Small-Group Markets hosted by America’s Health Insurance Plans (AHIP) on March 8 in Washington D.C. The consultants will talk about the role that reinsurance and high-risk pool programs may play in the individual market. The talk is based on their published paper “Reinsurance and high-risk pools: Past, present, and future role in the individual health insurance market.”

For more information about the conference, click here.

What must issuers of pediatric dental benefits consider with AV ranges gone?

The draft Notice of Benefit and Payment Parameters for 2019 was published in October 2017. In this rule, there is a significant change affecting dental benefit plans—removing Actuarial Value (AV) requirements for Patient Protection and Affordable Care Act (ACA)-compliant standalone pediatric dental plans. This change in policy provides new flexibility for dental issuers and closer alignment of pediatric dental benefits between standalone dental plans and pediatric coverage embedded within an ACA medical plan.

In this paper, Milliman consultant Joanne Fontana discusses this change and why it will be critical for dental issuers to understand and act on as the 2019 pricing cycle starts.

Law and Executive Order: A look at how President Trump’s executive order on healthcare impacts the ACA’s small group and individual markets

The Presidential Executive Order Promoting Healthcare Choice and Competition Across the United States, signed by President Trump on October 12, could have a significant effect on both the individual and small group health insurance markets. The extent of any impact on either market will vary depending on how the executive order is interpreted and implemented by administrative agencies as well as whether those interpretations hold up to legal challenges.

This article by Milliman consultants Fritz Busch, Erik Huth, Nicholas Krienke, and Jason Karcher summarizes the executive order and analyzes key considerations and potential impacts for commercial health plans.

Implication of coding on risk adjustment and valued-based contracting

Healthcare providers are measured on certain performance metrics that dictate their payment amounts under value-based contracts. Risk adjustment plays an integral role in determining financial performance. In order for these contracts to be equitable for insurers and providers, risk adjustment must accurately capture changes in population morbidity to effectively measure the provider’s true cost impact.

In this article, Milliman’s Rong Yi, Howard Kahn, and Jared Hirsch highlight common data issues that affect risk scores. They also discuss practices that can improve coding efforts related to risk adjustment.

Selling insurance across state lines: Intended and unintended consequences

Proponents believe that selling insurance across state lines without being subject to state-specific regulations would increase competition and lower insurance costs. This proposed change could result in critical intended and unintended consequences, which depend greatly on policy intent and design. Milliman consultant Susan Philip provides some perspective in this article.

Risk adjustment modifications in view of potential CSR subsidy termination

If the cost-sharing reduction (CSR) subsidies of the Patient Protection and Affordable Care Act (ACA) were eliminated, it could expose insurance carriers to a substantial increase in selection risk related to their particular mixes 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.