In the United States in 2014, more than 3 million individuals were estimated to have chronic hepatitis C virus (HCV) infection, including many undiagnosed individuals. In 2012, the Centers for Disease Control and Prevention expanded its HCV testing recommendations to target all adults born between 1945 and 1965, in addition to at-risk individuals. This has led to an increase in newly diagnosed patients. Few studies have explored the medical cost or clinical status of patients who are newly diagnosed with HCV. This research by Milliman consultants compares the demographics, comorbidities, and medical costs of patients who are newly diagnosed and those who were previously diagnosed with HCV infection.
More people die from lung cancer globally than any other form of cancer. The disease is expected to kill over 154,000 people in the United States alone in 2018. Most recent reports about treating lung cancer have focused on innovative treatments around immunotherapy. But an alternative form of disease management exists that has been getting press attention: catching the disease early via CT scan.
Jim Mulshine, a thoracic medical oncologist by training who spent 25 years at the National Cancer Institute, and Bruce Pyenson, a consulting actuary at Milliman, sat down for a Q&A to discuss lung cancer and provide a medical and actuarial take around finding lung cancer early via CT scan.
In this Q&A, Mulshine, now at Rush University Medical Center, and Pyenson discuss the prognosis and progression of lung cancer, various treatments for the disease, including CT screening, and what future treatment could look like.
Major efforts to improve the care and reduce the cost of heart failure patients have recently been implemented. Despite these efforts, however, the rate of heart failure is rising and only small improvements in survival have been realized. The lack of novel therapies and limited improvement in medical management highlight the need for more focus on heart failure, especially among the Medicare population. Milliman consultants Bruce Pyenson, Kate Fitch, and Pamela Pelizzari provide some perspective in this report.
The opportunity to reduce Medicare claims cost in the Bundled Payment for Care Improvement Initiative (BPCI) of the Center for Medicare and Medicaid Innovation (CMMI) is typically in the post-acute care (PAC) period. Analyzing the opportunity to reduce Medicare PAC spending requires providers to adopt a payor state of mind—payor tools and approaches will be very helpful. Benchmarking to best practices is one of those tools.
Milliman has developed nationwide average and well-managed (WM) benchmarks for PAC periods of one to 30, 31 to 60, and 61 to 90 days. Milliman’s Bruce Pyenson, Kate Fitch, Michele Barrios, and Tyler Engel provide perspective in this healthcare reform paper.
It will be easier for people with blood cancer and other serious conditions to get healthcare coverage under the Patient Protection and Affordable Care Act (ACA). However, the ACA permits variation among exchange plans, which could mean significant differences in services to people with blood cancer.
This report by Bruce Pyenson and Jane Suh provides an early look at the 2014 individual benefit designs and premiums for policies sold on state exchanges in California, New York, Florida, and Texas. The report also reviews which drugs, cancer centers, and transplant centers are covered and discusses the role of out-of-pocket limits, as blood cancer treatment can be expensive and out-of-pocket limits will not apply to non-covered treatments and treatment centers.
Changes from the Patient Protection and Affordable Care Act (ACA) are dominating the healthcare landscape. These changes are very important for people infected with the hepatitis C virus (HCV). Last year there was an increased federal public health effort aimed at diagnosing people with HCV. Baby Boomers, the generation with the most HCV-infected people, has started to become eligible for Medicare.
Further, new treatments for HCV are under development. Undiagnosed individuals and uninsured individuals may represent a population that payors and stakeholders have not yet experienced. This paper discusses how increased diagnosis, increased Medicare eligibility, and newly insured individuals with HCV will affect the U.S. healthcare system.