Organ and tissue transplants are a vital but expensive healthcare service in the United States, but there is little research available that measures transplant cost trends. The 2017 edition of Milliman’s triennial report was released in August and provides a better understanding for providers, insurers, and consumers of the billed charges associated with organ transplantation.
Recently, Milliman released an infographic that sums up the key findings in the report. A similar infographic was featured in the September issue of Fortune magazine and in the September 14th online edition.
Milliman has released the 2017 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 and 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, when compared to all combined organ and tissue transplants in the 2014 report, billed charges saw an average annual increase of 3.5% for those under 65, and 7.7% for those over 65. The analysis also revealed a dramatic decrease in wait times for kidney transplants and intestine transplants, while wait times for organs such as heart and pancreas have increased since the 2014 report. Survival rates have generally increased slightly when compared to Milliman’s previous report.
Organ and tissue transplants are a vital but expensive healthcare service, and the costs for these transplants are not readily available. This research is an important tool for providers, payers, and the public to better understand the utilization and billed charges surrounding organ and tissue transplantation.
To view the complete report, click here.
Some carriers can benefit from offering Medicare Supplement (MedSupp) as an alternative to Medicare Advantage (MA). In this article, Milliman consultants Ken Clark and Scott Bentley discuss the following four reasons why carriers should consider adding MedSupp to their Medicare product line:
• Enrollment of seniors who otherwise won’t enroll in MA
• Enrollment of seniors in service areas where developing an MA provider network isn’t practical
• A potential hedge against a decrease in the value of MA products for consumers
• Simplicity and flexibility for the health plan
This 2014 report summarizes estimated U.S. average costs per member per month, billed charges, and utilization related to transplant admission for treatment for organ and tissue transplants. There are some new developments to report since 2011 when the last report was released. Since that time, there have been annual increases in per member per month costs for certain types of transplants. Survival rates have generally shown mixed improvement and decline by transplant. However, hospital lengths of stay for most transplants have not changed much since the 2011 report.
The Wall Street Journal today published 2012 Milliman data on organ transplants. Here is the excerpt:
Organ transplantation—from procurement of organs to transplant to the first year of postoperative care—is a $20 billion per year business. Recipients of single-organ transplants—heart, intestine, kidney, liver, single and double lung and pancreas—are charged an average $470,000, ranging from $288,000 for a kidney transplant to $1.2 million for an intestine transplant, according to consulting firm Milliman.
To see Milliman’s 2011 U.S. organ and tissue transplant cost report, click here.
This report summarizes estimated U.S. average costs per member per month (PMPM), billed charges, and utilization related to the 30 days prior and 180 days after admission for treatment for organ and tissue transplants. For charges pre- and post-transplant admission, we include all medical costs associated with the transplant patient. Organ transplants include single-organ transplants such as heart, intestine, kidney, liver, lung, pancreas, and a number of multiple-organ transplants. Tissue transplants include bone marrow and cornea transplants.
You’ll find the report here.