Genetic testing in England: ROI, cost-effectiveness analysis, or both to evaluate intervention

In healthcare, return on investment (ROI) can be used to measure the effectiveness of various disease management programmes. ROI provides a framework to help determine whether additional funds should be allocated to a particular activity or alternatively whether these funds should be withdrawn and allocated elsewhere. The rapid uptake of genetic testing within the National Health Service (NHS) and current debate around genetics make evaluating tailored interventions increasingly more relevant to ensure an efficient use of NHS spend. Milliman’s Joanne Buckle and Didier Serre provide perspective in this paper.

Medicaid risk-based managed care: Analysis of administrative costs for 2016

In this report, Milliman consultants summarize calendar year 2016 administrative costs of organizations reporting Medicaid experience under the Title XIX Medicaid line of business on the National Association of Insurance Commissioners (NAIC) annual statement. The primary purpose of the report is to provide reference and benchmarking information for certain key administrative expense categories used in the day-to-day analysis of Medicaid managed care organization (MCO) financial performance. It also explores the differences among various types of MCOs using available segmentation attributes defined from the reported financial statements.

Medicaid risk-based managed care: Analysis of financial results for 2016

This report by Milliman’s Jeremy Palmer and Chris Pettit summarizes calendar year 2016 financial results of organizations reporting Medicaid experience under the Title XIX Medicaid line of business on the National Association of Insurance Commissioners (NAIC) annual statement. The primary purpose of this report is to provide reference and benchmarking information for certain key financial metrics used in the day-to-day analysis of Medicaid managed care organization (MCO) financial performance. This report explores the differences among various types of MCOs using available segmentation attributes defined from the reported financial statements.

First quarter financial results for medical professional liability specialty writers

This article by Milliman’s Eric Wunder and Brad Parker summarizes key financial results for medical professional liability writers from the first quarter of 2017. First-quarter premiums declined for the 11th consecutive year, dropping below the $2 billion mark for the first time since 2002. The 3.1% decrease relative to Q1 2016 is consistent with the average annual decrease seen during the past five years.

This article was originally published in the July 2017 issue of the Medical Liability Monitor.

How the Medicare Advantage 2018 RxHCC risk score model update impacts plan risk scores

The Centers for Medicare and Medicaid Services finalized a Part D risk score model for payment year 2018. How does this model update affect plan risk scores? This paper by Milliman consultants Adrian Clark and David Koenig summarizes the changes in member risk scores that are due to the RxHCC risk score model update.