As of January 1, 2021, regulations require U.S. hospitals to post to their websites all of their negotiated payment rates in one sprawling machine-readable file, although many hospitals may not meet the initial deadline. The aim of the regulation is to increase price transparency with the goal that such transparency will lead to increased competition, improved customer choice, and ultimately lower prices. There will be challenges, though, to extract useful competitive information from the files. This article by Milliman professionals examines those challenges.
Stop-loss coverage is purchased by self-insured employers looking for coverage from catastrophic medical and pharmacy claims. Based on the most recent data available from S&P Global Intelligence, the stop-loss market stands at approximately $24 billion in premium.
In March, Milliman sent survey participation requests to a wide range of employer stop-loss market participants. Of those receiving a request, 25 provided survey responses. This survey is an update to Milliman’s prior employee stop-loss market survey, which was published in May 2019.
In this paper, Milliman’s Rob Bachler, Nick Johnson, Brian Reed, and Mike Hamachek summarize the findings from the most recent stop-loss survey.
Starting in 2019, many clinicians performing services for Original Medicare patients will have their payments adjusted based on quality and other metrics from 2017. The Merit-Based Incentive Payment System (MIPS) is a revenue-neutral program that will adjust Part B payments, with a maximum -4% penalty in 2019.
MIPS was passed into law as part of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). For 2017 dates of service, eligible clinicians (ECs) recorded and submitted measurements across three key areas: quality, improvement activities, and advancing care information (now called promoting interoperability). Based on these areas, ECs received a final score between 0 and 100, which then affects their payment rates for Medicare Part B services in 2019. The program is revenue-neutral, meaning the bonus payments will be adjusted based on the level of penalties.
In this article, Milliman’s Christopher Kunkel and Mike Hamachek provide several interactive charts that enable users to explore some of the results of the 2017 reporting.
Stop-loss coverage is purchased by self-insured employers
looking for coverage from catastrophic medical and pharmacy claims. Based on
the most recent data available from S&P Global Intelligence, the stop-loss
market stands at approximately $20 billion in premium.
In March 2019, Milliman sent survey participation requests
to approximately 30 employer stop-loss carriers, and 25 provided responses. The
survey asked questions about various topics, including:
- Portfolio characteristics, such as employer size
and types of coverage purchased
- Underwriting measures, such as persistency and
- Pricing measures, such as a carrier’s average
discretionary discount and target loss ratios
- Historical results, both loss ratio and growth
- Product terms offered
In this paper, Milliman’s Rob Bachler, Nick Johnson, and Mike Hamachek provide results of the survey.