The U.S. Food and Drug Administration recently granted emergency approval for the Pfizer COVID-19 vaccine and approval of the Moderna vaccine followed shortly. In November, Pfizer and BioNTech announced a successful Phase 3 study of a vaccine against COVID-19 with an efficacy of over 90%. Days later, Moderna made a similar announcement with the development of a vaccine having an efficacy of nearly 95%. These announcements were met with renewed hope that life will soon return to pre-pandemic normalcy.
Employers have become increasingly anxious to see a return to normal business practices after months of disruption due to COVID-19. The vaccines offer hope that businesses will be able to prepare to roll out plans to return to pre-pandemic practices in the near future. In this paper, Milliman’s Les Kartchner and Brent Jensen present considerations for employers as these new vaccines are made available.
While there is a great deal of focus on resource availability and handling a potential influx of severe inpatient cases resulting from COVID-19 infections, the majority of the United States saw a dramatic reduction in healthcare services around March and April 2020 and measurable reductions continue with great variation across the nation.
As with many prospective risk adjustment models, Medicare Advantage (MA) and Part D (PD) risk scores are based on medical claims, more specifically diagnoses from face-to-face visits from the year prior to the year in which the risk score drives revenue. For 2021 MA payments, 2020 diagnoses are the basis of the final risk scores. To the extent that beneficiaries delay or avoid care, there may be fewer face-to-face encounters with providers where diagnoses can be recorded and applied toward 2021 risk scores.
While the Centers for Medicare and Medicaid Services has announced additional flexibilities in including telehealth-based diagnoses in risk score calculations, a significant reduction in overall services is likely to result in a material reduction in both MA and PD risk scores. In this article, Milliman’s Rob Pipich, Karin Cross, and Deana Bell discuss the results of an analysis they performed to support 2021 MA and PD bids. They present nine scenarios intended to illustrate a range of potential outcomes on 2021 MA and PD risk scores.
The COVID-19 pandemic and the mitigating actions in response by citizens and governments alike have precipitated unprecedented economic disruption in the United States. The second quarter of 2020 marked the largest single-quarter economic contraction in modern U.S. history, driving unemployment rates from historically low levels in February to peaks last seen during the Great Depression.
The unraveling and recovery of the U.S. economy have had and will continue to have a similarly disruptive influence on the enrollment in and composition of U.S. health insurance markets. These impacts will be felt throughout the health system, including in state Medicaid budgets and hospital, physician, and pharmaceutical margins, as well as in the financial performance of commercial and Medicaid health plans.
To understand the interconnected nature of economic changes and health insurance coverage and to project impacts to U.S. health insurance markets, Milliman built a tool referred to as the COVID-19 Advanced Population Shift model. This model combines detailed information on the economic status, health insurance coverage, and health status of each state’s population prior to the COVID-19 pandemic with emerging information on the economic impact of the pandemic response. It allows forecasting the resulting shifts in enrollment and population morbidity across the healthcare markets while providing insight into the key factors driving change. Milliman’s Fritz Busch, Lindsy Kotecki, and Jeff Milton-Hall summarize the findings in this paper.
The COVID-19 pandemic has dramatically increased the use of telehealth. In this episode of Critical Point, Milliman’s Susan Philip and Mei Kwong, executive director of the Center for Connected Health Policy, talk about what the rise of telehealth could mean for the future of healthcare in the United States. They also discuss what providers, payers, and patients should know about this virtual healthcare service.
To listen to more episodes of Critical Point, click here.
Emerging data from around the world suggest that nursing home residents are at exceptionally high risk for contracting COVID-19, with some areas reporting that close to half of regional deaths are either in nursing homes or in hospitals after admission from a nursing home. Less than 0.5% of Americans live in nursing homes, but the remarkable concentration of risk in such facilities may have profound implications on how we handle the pandemic.
In this article, Milliman’s Bruce Pyenson and Harvard’s David Grabowksi discuss why nursing homes have been hit so hard by COVID-19 and what can be done to fight the disease in these facilities.
Vaccinations have historically been shown to boost a person’s immune system, eliminate and prevent the spread of infections, and lessen the burden on the healthcare delivery system. The concept of using vaccines has been around since the 1500s with several accounts describing smallpox inoculation as practiced in India and China.
Vaccines undergo strict testing and research under U.S. Food and Drug Administration (FDA) standards prior to becoming available to the public. Vaccinating populations has helped countries take steps toward wiping out debilitating and deadly infections such as polio and smallpox.
In view of the COVID-19 pandemic, Milliman’s Stephen George has written a new paper focusing on:
- Examining why, when, and how vaccines are used
- Highlighting the vaccine development pathway
- Reviewing previous experience with viral pandemics
- Assessing ways payers can address COVID-19