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.
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.
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.
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.
Many health systems around the world are introducing new care models which claim to replace expensive acute inpatient care with more primary and community-based services. This paper by Milliman consultants examines the primary care redesign of seven US practices over the course of three years, including their reported utilisation and savings achievements.
The high cost of therapy for patients with chronic hepatitis C (HCV) infection has been an important topic of discussion for key stakeholders in pharmacy benefit design and management. Multiple effective treatments have been introduced, with cure rates approaching 100%.
Although costly, curing HCV early on can prevent serious liver complications, such as hepatic cirrhosis, organ failure, and cancer, for the approximately 2.7 million affected people in the United States.
In 2016, there was a downward cost and utilization trend for the HCV Specialty category. Express Scripts reported in its 2016 Drug Trend Report that utilization of HCV therapies had decreased by 27.3% and the unit cost had decreased by 6.7%. The cost per member per year (PMPY) for HCV drugs decreased to $25.26 PMPY from $38.44 PMPY the previous year.
Why have cost and utilization suddenly decreased after two years of steady growth?