The COVID-19 pandemic has spurred—and aggravated—a range of mental health and substance use issues in the United States. In this episode of Critical Point, Milliman’s Stoddard Davenport discusses the rising demand for mental health services and how different populations are being affected. Stoddard also highlights recent statistics on the topic and what the road ahead may look like for mental health in America.
To listen to other episodes of Critical Point, click here.
COVID-19 has had a financially debilitating effect on many medical practices. Some practices are not expected to survive. The impact has been felt by physicians as well as other healthcare entities and led to severe declines in fee-for-service revenue. The pandemic also caused the Center for Medicare and Medicaid Innovation to make adjustments to its Direct Contracting (DC) program. DC adjustments include adding a second cohort that begins January 2022, providing a capitation payment glide path, and increasing physician capitation choices.
These changes create an opportunity for organizations considering becoming Direct Contracting Entities (DCEs) to attract physicians who may not have been interested in the program previously. The application window for the second cohort of DCEs opens in March 2021. In this brief, Milliman’s Coleen Young, Hugh Larson, and Annie Man discuss DC and the impact of COVID-19 on physicians.
The COVID-19 crisis and the enforced lockdowns and shelter-in-place orders worldwide have accelerated the relevance and usage of telehealth, which has major implications for health insurers. The usage of telehealth has been limited historically. For example, 92% of U.S. consumers reported that they were not using telehealth prior to the onset of the COVID-19 pandemic.
In this paper, Milliman professionals examine the current status of telehealth in major geographic markets, including the U.S., Europe, and Asia. They develop a framework for telehealth with its key market participants, including a typology of models of virtual care. They also explore insurer proposition design and cost containment.
The U.S. Food and Drug Administration recently granted emergency approval for the Pfizer COVID-19 vaccine and approval of the Moderna vaccine followed shortly. In November, Pfizer and BioNTech announced a successful Phase 3 study of a vaccine against COVID-19 with an efficacy of over 90%. Days later, Moderna made a similar announcement with the development of a vaccine having an efficacy of nearly 95%. These announcements were met with renewed hope that life will soon return to pre-pandemic normalcy.
Employers have become increasingly anxious to see a return to normal business practices after months of disruption due to COVID-19. The vaccines offer hope that businesses will be able to prepare to roll out plans to return to pre-pandemic practices in the near future. In this paper, Milliman’s Les Kartchner and Brent Jensen present considerations for employers as these new vaccines are made available.
The introduction of the Patient Protection and Affordable Care Act (ACA) brought about many legislative changes intended to improve the health of people in the United States. One such change was the introduction of mandatory coverage with no cost sharing for services determined to be “preventive.” Some examples of the services included on the A and B Recommendations lists of the U.S. Preventive Services Task Force (USPSTF) are blood pressure screening for adults, depression screening for adolescents and adults, intimate partner violence screening for women of reproductive age, and skin cancer behavioral counseling.
The USPSTF regularly updates its recommendations and the ACA preventive services list has been modified many times since the introduction of the ACA in 2014. In this paper, Milliman’s Barbara Collier and Michelle Klein examine the evolution of preventive services. They also discuss how these services have been impacted by the COVID-19 pandemic.
Health actuaries have seen unprecedented challenges this year because of the ongoing COVID-19 pandemic. It has disrupted all facets of the U.S. healthcare system. How the pandemic affects an insurer’s financial statement will vary based on the distribution between lines of business, areas of service, and support channels.
As chief financial officers and actuaries attempt to determine the pandemic’s effect on year-end financial statements, the following five issues will require additional attention:
Premium deficiency reserves
Provider financial solvency
Incurred but not reported (IBNR) claim estimates
Patient Protection and Affordable Care Act (ACA) risk adjustment
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