Category Archives: Cost

Individual stop-loss is now optional for Next Generation ACOs

Next Generation Accountable Care Organizations (NGACOs) now need to choose between whether they want to have their annual financial reconciliation based upon capped claims or uncapped claims. Previously, they didn’t have a choice and reconciliations were based upon capped claims. For some NGACOs, the choice between an annual financial reconciliation based upon capped claims or uncapped claims could have a significant impact. Milliman consultants provide more perspective in this paper.

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.

What actuarial skills are important to the NHS?

Actuarial skills are immensely relevant in regional National Health Service (NHS) environments and can be used to inform the design of risk-based accountable care system (ACS) contracts. An article in The Actuary by Milliman’s Joanne Buckle and Tanya Hayward highlights their recent experience helping to develop an ACS within a subsegment of the NHS encompassing a small number of clinical commissioning groups and local councils.

Considerations for comparing 30-day unplanned readmission rates

Hospital readmissions can add unnecessary cost to the healthcare system and can adversely affect patient health. Readmission rates are key metrics for measuring the performance of hospitals, health plans, accountable care organizations (ACOs), physicians, and post-acute care facilities because they are tied to financial rewards and penalties for those entities. This article by Milliman consultants Maggie Alston and Michele Berrios identifies key elements that should be considered when evaluating readmission rates across populations or when comparing readmission rates with different methodologies.

Infographic: The cost of organ and tissue transplants in America

Organ and tissue transplants are a vital but expensive healthcare service in the United States, but there is little research available that measures transplant cost trends. The 2017 edition of Milliman’s triennial report was released in August and provides a better understanding for providers, insurers, and consumers of the billed charges associated with organ transplantation.

Recently, Milliman released an infographic that sums up the key findings in the report. A similar infographic was featured in the September issue of Fortune magazine and in the September 14th online edition.

Prevalence, treatments, and medical cost of multiple sclerosis in Japan

The prevalence of multiple sclerosis (MS) in Japan is relatively low compared with that in the United States and Europe. However, the number of MS patients in Japan has been steadily increasing in recent years. This article coauthored by Milliman’s Kosuke Iwasaki and Yusuke Nakamura analyzes health insurance claims data to determine the current treatment status and medical cost of MS in Japan.

This article was originally published in Clinical and Neuroimmunology.