Tag Archives: Nick Ortner

Infographic: Key findings on the cost of organ and tissue transplants in the United States

Milliman’s triennial report, “2020 U.S. organ and tissue transplants: Cost estimates, discussion, and emerging issues” provides a summary of estimated U.S. average utilization, billed charges, and resulting per member per month costs for organ and tissue transplants. It also explores projected trends in hospital waiting times, survival rates, and emerging innovations and issues in the transplant space.

The infographic below illustrates key findings and trends from the report.

Milliman report on U.S. organ and tissue transplants projects 11% rise in average annual cost in 2020

Milliman today released the 2020 edition of its triennial report on the estimated costs of U.S. organ and tissue transplants. The report summarizes average annual costs per member per month (PMPM), including utilization and billed charges, related to the 30 days prior through 180 days after transplant admission for organ and tissue transplants. This includes single-organ transplants such as heart, intestine, kidney, liver, lung, and pancreas, and a number of multiple-organ transplants. Tissue transplants include bone marrow and cornea.

While the findings vary greatly by transplant and population type, the study found that, for all combined organ and tissue transplants, per member costs based on billed charges saw an average annual increase of 11% for those under age 65, and 10.5% for those age 65 and over when compared to the 2017 report. The analysis also examined trends in hospital lengths of stay, average waiting times for organs, and changes in survival rates between our 2017 and 2020 reports, with results varying by transplant.

New this year, the report also explores emerging innovations and issues in the areas of organ viability and availability, such as the use of bioengineering, xenotransplantation, and anti-hepatitis C drugs to combat shortages and growing wait lists.

There are a number of scientific and policy initiatives geared at improving the availability of and access to much needed organ and tissue transplants. As new technologies emerge, Milliman’s research will continue to be an important tool for physicians, insurers, and the public to better understand the utilization, billed charges, and related trends associated with this vital healthcare service.

To view the complete report, click here.

Implications of proposed changes to short-term medical plans

In February 2018, the Departments of Health and Human Services (HHS), Labor, and the Treasury released a proposed rule that would change the maximum duration of short-term, limited-duration insurance (STLDI) policies. Under the proposed rule, STLDI plans, or “short-term medical” plans, may emerge as an alternative form of individual health insurance. In this article, Milliman actuaries Jason Karcher and Nick Ortner discuss the proposed changes and the potential effect they might have on the individual health insurance market.

Mini-medical plans and the “what can I afford” question

Prior to the Patient Protection and Affordable Care Act (ACA), mini-medical plans had no standard meaning, though they typically shared a few characteristics. Such plans provided limited coverage that could be exhausted quickly and/or result in significant out-of-pocket expenses if enrollees needed comprehensive services.

Total annual benefit limits may have been as high as $250,000 with more typical limits ranging from $10,000 to $50,000. Coverage was provided on an expense-incurred basis and used for traditional comprehensive health insurance, with lower premiums the trade-off for dollar-value benefit levels that fell below traditional health insurance.

The ACA effectively eliminated the expense-incurred mini-med market with the prohibition of annual limits on essential health benefits. What role might mini-med plans play in a post-ACA environment? Milliman’s Nick Ortner provides perspective in his article “What can I afford? Mini-med 2.0 and cost-coverage questions in a post-ACA world.”