Milliman

Recording: CMS Final Notice - Targeted analysis for Alliance member health plans
Immediately after the final notice’s release, the industry’s airwaves are filled with breakdowns, summaries and recaps from consultants and analysts. After you get the 101 from the other guys, plan on joining your Alliance peers for this 90 minute webinar, which isn’t about the general take aways -- Instead, it’s all about you.

Recording: Reimbursement strategies in government programs
Contracting with providers is a key component of operating a health plan. While provider reimbursement based on a fee schedule is still very common, a shift in reimbursement strategies has started. This presentation from Milliman will highlight some of the key issues to consider when negotiating an alternate payment arrangements.

Presentation: Reimbursement in Government Programs
Contracting with providers is a key component of operating a health plan. While provider reimbursement based on a fee schedule is still very common, a shift in reimbursement strategies has started. This presentation from Milliman will highlight some of the key issues to consider when negotiating an alternate payment arrangements.

PROPOSAL: 2016 Milliman Medical Cost Benchmark Survey Proposal Overview
2016 Milliman Medical Cost Benchmark Survey

Presentation: Enhancing risk adjustment transfers with benefit design, formulary and provider contracting
This session will focus on non-coding approaches to boost risk scores. Specifically, we will discuss tactical approaches a health plan can implement that may enhance risk adjustment transfers. Topics will include items such as plan design considerations, prescription drug formulary, and provider contracting.

Audio: Enhancing risk adjustment transfers with benefit design, formulary and provider contracting
This session will focus on non-coding approaches to boost risk scores. Specifically, we will discuss tactical approaches a health plan can implement that may enhance risk adjustment transfers. Topics will include items such as plan design considerations, prescription drug formulary, and provider contracting.

Coding improvement for commercial exchange plans
As we end the second year with plans offered in the ACA marketplace, health insurance companies are trying to understand the value and potential return on investment of ensuring accurate and complete coding of diagnoses in order to maximize risk scores.

Aligning Payer-Provider Incentives to improve coding and ACA risk transfer payments
With the passage of the Patient Protection and Affordable Care Act (ACA), many commercial health plans were subject to risk adjustment for the first time in 2014. Experience for 2014 showed the impact of risk adjustment can be substantial, and health plans operating under the ACA need a thoughtful, innovative plan for managing risk scores. While providers may not realize it yet, the increased focus by health plans on coding will also have implications for providers and the incentive structures they establish with health plans.

Presentation: Creative Benefit Design in MA
One Alliance member relatively new to MA and one a long-time veteran discuss their approach to creative benefit design.

Milliman Report_2016 formularies under the ACA
Among observers who noted the variation in formulary design and breadth across Medicare Part D landscape, some have questioned whether such formulary variation would spill over into the health insurance exchanges (HIX) established by the Patient Protection and Affordable Care Act (ACA). At this point, the HIX pharmacy coverage in effect for almost two years now, we reviewed actual formularies in a handful of states where the information was publicly available for both HIX and non-HIX products. We assessed the breadth of formulary coverage on a basis of total allowed cost and utilization by medication type, separately for individual and small group products.