Category Archives: Healthcare Intelligence

Looking at cancer trends through Milliman UK Health Cost Guidelines

Milliman’s UK Health Cost Guidelines™ (HCGs) is a tool for modelling health costs and utilisation from a payer perspective to provide a consistent way to price and analyse claims experience. The 2016 Milliman UK HCGs cover a significant proportion of the private medical insurance (PMI) market, comprising base tables for each sector of the market: corporate, small and medium enterprises (SMEs), and the individual market.

Further analytics include looking at cancer trends and cancer specific costs by service lines. In this article, Milliman’s Joanne Buckle, Neha Taneja, and Natasha Singhal provide an introduction to the HCGs. They also provide perspective on their HCGs analysis, focusing primarily on cancer-related research and future projections in cancer trends.

Benchmarking analytics for provider reimbursements

Managing provider reimbursement levels is an important function for health plans. Provider reimbursement analytics can offer health plans the foundation they need to effectively manage reimbursements.

In their article “Provider reimbursement analytics,” Milliman consultants David Lewis and Charlie Mills highlight the advantages and disadvantages of the two primary analytical approaches for evaluating provider reimbursement levels. The authors also discuss the pros and cons of the three main baseline fee schedules used in provider contract benchmarking, one of which includes Milliman GlobalRVUsTM.

Milliman Advanced Risk Adjustment™ (MARA™) software tops the competition in risk scoring study

laurent-dianeMilliman’s popular Milliman Advanced Risk Adjusters™ (MARA™) software topped the competition in the latest study by the Society of Actuaries (SOA), “Accuracy of Claims-Based Risk Scoring Models.” Milliman achieved the highest overall performance among concurrent models, beating out 11 other vendors. MARA’s prospective models scored similarly well, ranking at or near the top in all four primary metrics measured.

MARA’s performance is proof of what we’ve known all along—the Milliman Advanced Risk Adjusters software is a leader in claims-based risk scoring models, and one of the most accurate tools on the market.

Since the passage of the Patient Protection and Affordable Care Act (ACA), risk scoring models play a central role in predicting or explaining healthcare expenditures. As in each of the previous SOA studies, coefficient of determination, or R2, was used as one measure of predictive accuracy and indicates how well data fit a statistical model. With an R2 of 55.4%, MARA’s concurrent diagnosis and pharmacy model (CxAdjuster) leads the competition with the highest observed R2 for uncensored costs. For costs censored at $250,000, the same model achieved the highest R2 to occur in the study, at 66.7%.

We were especially pleased that in an exploration of ensemble methods of modeling, more weight was put on the MARA model than any other. To me that indicates that giving MARA the most credence resulted in the best performing composite prediction.

MARA models are valued by clients because they produce separate risk scores for major categories of service, including inpatient, outpatient, emergency room, physician, pharmacy, and other medical care. Beyond risk scores, all MARA models provide a probability of inpatient admission and emergency room visits, plus the contribution of clinical risk drivers for more than 1,000 medical conditions.

The study, released Monday October 25, is published by the Society of Actuaries.

Milliman MedInsight chosen by two state-based organizations and a leading community coalition to identify unnecessary costs and procedures in healthcare delivery

Milliman announced today that its healthcare tool, the MedInsight® Health Waste Calculator, has been chosen by two state All Payer Claims Databases (APCDs) and a leading Regional Health Improvement Collaborative to aid in their identification of unnecessary costs and procedures in healthcare delivery.

The Virginia Center for Health Innovation (VCHI), Oregon Health and Hospitals, and the Washington Health Alliance (WHA) have all licensed the MedInsight Health Waste Calculator to support their statewide initiatives to identify and eliminate waste in their healthcare systems.

“In Virginia, an important component of our state health innovation plan is to reduce utilization of low-value medical tests and procedures so that we can free up needed resources to advance high-value care. Our medical and business communities want to do what they can to better ensure that patients and providers are choosing wisely when it comes to healthcare,” said Beth Bortz, President and CEO of VCHI.

The Health Waste Calculator is an analytic tool that is powered by Milliman’s MedInsight software and encapsulates Value-Based Insurance Design (VBID) Health’s market knowledge on wasteful healthcare spending. The tool identifies and quantifies the use of unnecessary or potentially harmful clinical services, including those defined by national initiatives such as the U.S. Preventive Services Task Force and Choosing Wisely. Using the Health Waste Calculator, each state will be able to report on countless aspects of healthcare but the typical starting points are reports by county, region, or even health system, using these metrics:

• Percentage of individuals exposed to at least one potentially wasteful service.
• Percentage of potentially wasteful services in each market, what is called the Waste and Quality indices.
• Cost metrics of the waste impact as a baseline for them to work from as they implement strategies to realize greater efficiencies.

Mark Fendrick, Director of VBID, stated, “The achievement of Triple Aim in healthcare is to improve quality, enhance patient experience, and lower costs, which requires us to spend more on evidence-based services and less on those that do not produce health. The MedInsight Health Waste Calculator can identify, and potentially reduce, the use of low-value services to free up needed resources to reduce important gaps in care.”

MedInsight is used by over 300 health plans, employers, at-risk providers/accountable care organizations (ACOs), state governments, community health coalitions, and third-party administrators.

For more information about Milliman’s MedInsight products, click here.

Milliman MedInsight’s analytic platform named a leader in IDC MarketScape report

Milliman today announced that its popular healthcare analytic platform, MedInsight, has been named a leader in the IDC MarketScape study, entitled “U.S. Payer Data Analytics 2015 Vendor Assessment, doc #HI255269, April 2015.” The company is one of eight vendors evaluated in the report.

MedInsight is positioned as a leader of this IDC MarketScape report—which provides an evaluation of the leading payer data analytic platforms—because of high satisfaction ratings from clients in terms of the high degree of flexibility, advanced analytics, and analytic tools supporting multiple types of users.

The report notes that Milliman’s strengths include the MedInsight Data Confidence Model—a methodology applied as a data warehouse is being created, and then leveraged on an ongoing basis for client data management—as well as the MedInsight benchmarking function that enables clients to benchmark organizational performance against Milliman’s health research database.

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“The MedInsight mission is to provide analytic leadership and decision confidence to our clients. The fast-moving and uncertain nature of the healthcare industry demands a nimble and growing analytic platform,” said Kent Sacia, Milliman principal. “The IDC MarketScape report affirms the MedInsight team’s hard work toward that mission as we continuously commit to adding value to our clients.”

The IDC MarketScape vendor analysis model is designed to provide an overview of the competitive fitness of information and communications technology (ICT) suppliers in a given market. The research methodology utilizes a rigorous scoring methodology based on both qualitative and quantitative criteria that results in a single graphical illustration of each vendor’s position within a given market. The capabilities score measures vendor product, go-to-market, and business execution in the short term. The strategy score measures alignment of vendor strategies with customer requirements in a timeframe of three to five years. Vendor market share is represented by the size of the circles. Vendor year-over-year growth rate relative to the given market is indicated by a plus, neutral, or minus next to the vendor name.

For more information about Milliman’s MedInsight products, click here.

Milliman MedInsight releases employer group reporting solution for health plans

Milliman has announced the formal launch of its new MedInsight Employer Group Reporting (EGR) Solution. The MedInsight EGR Solution is designed for health plans to support the key function of client reporting; helping a health plan’s employer clients accurately understand the value they receive from their benefit spends and also providing realistic performance comparisons with other employers in the region.

MedInsight is Milliman’s popular healthcare analytic platform used by over 250 health plans, employers, at-risk providers/accountable care organizations (ACOs), state governments, community health coalitions, and third-party administrators (TPAs).

The MedInsight EGR Solution delivers clients the benefits of confidence and control, while reducing the time and energy required to achieve them. As an extension of the MedInsight Analytic Platform and a beneficiary of our MedInsight Data Confidence Model, it means that health plans and TPAs can feel confident the information they are providing is accurate and meaningful, even as it’s made available to employer clients through a self-service portal.

Milliman expects many of its existing commercial health plan licensees of MedInsight to add the EGR Solution to bolster client reporting capabilities.

With user-friendly dashboards, a preconfigured reporting library, and easy-to-publish summary performance reports, the MedInsight EGR Solution helps health plans satisfy employer reporting needs easily and confidently.

“The employer clients of health plans are demanding more transparency on the value of healthcare being provided to their employees,” said Rich Moyer, Milliman principal. “We believe the MedInsight EGR Solution will be a very effective tool for health plans to deliver healthcare information to their employer clients. The EGR portal is easy to use and integrated with the health plan portal MedInsight clients currently use.”

Specifically, the MedInsight EGR Solution helps health plans and TPAs demonstrate the value they provide, by reporting on data that will help employers make decisions related to:

• Managing current and future cost trends
• Quality of healthcare services provided to employees
• Wellness programs and population health management

The ability to effectively meet employer clients’ ever-increasing demands for information and transparency comes with competitive benefits for MedInsight clients. It strengthens relationships with employers and provides the meaningful information actually required to bend cost trends and improve health. And by including innovative features like the Health Waste Calculator and population health groupers, MedInsight is providing them with value-add that extends to their employer clients.