Category Archives: Utilization

COVID-19 considerations for pet insurance industry

The 2019 State of the Industry report from the North American Pet Health Insurance Association shows continued growth in the pet health insurance market. At the end of 2018, nearly 2.43 million pets were insured in the United States, an increase of 18% from 2017.  Gross written premium also shows similar increases, growing to $1.3 billion at the end of 2018.

Despite this growth, veterinary daily visits have fallen nearly 19% year over year from March 25 through April 5 as a result of social distancing efforts related to COVID-19.  With the decrease in veterinary visits, it’s almost certain that the pet health insurance industry is going to be impacted by COVID-19. At this point, it’s unclear whether that impact is going to be positive or negative.

In this article, Milliman’s Jamie Shooks explores how the pet health insurance industry could be affected by the COVID-19 pandemic.

Connecting the dots between social determinants and healthcare utilization

Growing recognition that social determinants are significant drivers of health and healthcare utilization patterns has increased the desire to better understand and identify these issues as well as to develop actionable steps at both the population and member levels. There has been a growing focus on developing the ability to identify the presence of social vulnerabilities among population health entities, Medicaid state agencies, risk-taking provider organizations such as accountable care organizations, and any entity with a vested interest in the reduction of healthcare spending. It is not unusual for health actuaries to get involved in this discussion. Milliman’s Ksenia Whittal provides some perspective in this article.

This article was published in the December 2018/January 2019 issue of The Actuary.





Critical Point podcast: A primer on telehealth in the United States

NASA developed the first form of telemedicine to monitor astronauts in space over 50 years ago. Today, telehealth is being used to deliver healthcare in the United States to a population that might otherwise have difficulty accessing care. In this episode of Critical Point, Milliman’s Susan Philip provides a primer on telehealth including its uses, regulatory landscape, and efficacy. She also discusses some of the groundbreaking new devices using telehealth to deliver care.

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





Critical Point podcast: “Healthcare waste and how to find it”

Milliman’s new podcast, Critical Point, presents unique perspectives from the firm’s professionals. The podcast’s debut episode, “Healthcare waste and how to find it,” features Jackie Sehr, Marcos Dachary, and Dr. David Mirkin from Milliman MedInsight®, a data warehousing and healthcare analytics platform. In this episode, they discuss healthcare waste and approaches to minimize waste and reduce unnecessary costs across the American healthcare system.

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





Opioid prescription patterns affect risk scores

Opioid prescribing nationwide peaked in 2012 at over 80 prescriptions per 100 persons. Between 2012 and 2016, the prescribing rate decreased by almost 20%. Even after this decline, 19% of the U.S. population filled at least one opioid prescription during 2016.

As opioid prescribing declined, many doctors switched to other pain relief drugs. The change in prescribing patterns has potential implications for risk adjustment, because some of the drugs now being used for pain relief were previously flagged in pharmacy-based risk adjustment models as associated with high-cost conditions such as multiple sclerosis.

This brief by Christine Mytelka, Melanie Kuester, Colin Gray, and Lucas Everheart provides data on the decline in opioid prescribing and the increased use of other non-opioid pain relief drugs. Additionally, it addresses the corresponding effect that changing prescribing patterns may have on evaluating population health and risk-adjusted payments in risk-based managed care programs.





Impact of Mental Health Parity and Addiction Equity Act

What has happened to utilization and costs for mental health and substance use disorder benefits as the mental health parity laws and associated rules were slowly rolled out? This paper by Milliman consultants presents an analysis of healthcare utilization and cost patterns during the six-year period from 2008 through 2013 and suggests that the Mental Health Parity and Addiction Equity Act has driven increases in access to, and benefit richness for, mental health and substance use disorder benefits.