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.
Population health management (PHM) is a hot topic in the healthcare industry, but it means many different things to different people in different contexts. Deciding where to focus effort when developing PHM strategies and programmes is difficult without a clear policy framework and approach. Milliman consultants have written a guide to help managers think through the practical components of a PHM programme, from overall objectives and definitions through to the people. The guide also explores processes and technology enablers that are critical for success. Real-world case studies are referenced to demonstrate how the concepts discussed in the guide can be applied.
Diagnosis-related groups (DRGs) are the standard envisioned within the Cyprus General Healthcare System (GHS—or commonly referred to as “GESY”) as the process by which public and private hospitals will be reimbursed for their services.
As part of the GHS implementation, hospitals will need to employ a customised DRG system, with a catalogue of DRG codes and related definitions. It is envisioned that this will enhance efficiency in the delivery of hospital services, more so than other hospital payment models. In this paper, Milliman’s Nicholas Kallis considers the initial development of the DRG system in the United States to assess whether or not it’s worth implementing in Cyprus, and in what form.
This paper is the first in a series about DRG systems. The series will cover the definition and objectives of these systems. The papers will also explore how different nations have developed and adopted the payment mechanism and their main advantages and disadvantages.