Tag Archives: health insurance

Aspire health plan: How Monterey is reinventing healthcare

When confronted with rising costs and shrinking reimbursement, leaders at a respected regional hospital in California took a bold step to ensure that they could continue serving the needs of the community in a financially sustainable way.

Guided by Milliman’s health experts, the Community Hospital of Monterey Peninsula (CHOMP) launched a new insurance company, Aspire Health Plan, to expand regional access to coordinated, high-quality healthcare. What’s more, they invited a competing hospital to join them, forging a unique alliance that puts the health of the community first.

To learn more, watch the following video.

Top 15 U.S. articles and reports for 2016

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In 2016, Milliman consultants wrote articles and worked on studies covering a range of practices and areas. Healthcare was a hot topic again this year, and topics included value-based payments, risk adjustment, and the Medicaid managed care rule. Other articles—about student loan debt and daily fantasy sports—were also popular. Here’s a preview of the top 15 U.S. articles and reports for the year.

15. Financial analysis of ACA health plan issuers, By Daniel J. Perlman and David M. Liner

14. Are you ready for the new world of value-based reimbursement?, By Marla Pantano

13. Encounter data standards: Implications for state Medicaid agencies and managed care entities from final Medicaid managed care rule, By Jeremy Cunningham, Maureen Tressel Lewis, and Paul R. Houchens

12. The elusive nature of private exchanges, By Mike Gaal

11. Money market update for 2016: The rule that you should be aware of, By Jeffrey T. Marzinsky

For a summary and link to all of the articles, click here.

Top 15 global articles and reports for 2016

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Milliman’s most viewed articles worldwide in 2016 covered topics including pensions, student loans, value-based payments—and Pokemon Go. There were also pieces on Solvency II, encounter data standards, and managed care regulations. Here is a preview of the top 15 global articles and reports for the year.

15. Financial analysis of ACA health plan issuers, By Daniel J. Perlman and David M. Liner

14. Telemedicine and the long-tail problem in healthcare, By Jeremy Kush and Susan Philip

13. Public Pension Funding Study, By Rebecca A. Sielman

12. Life insurance risks: Observations on Solvency II and the modeling of capital needs, By Stephen H. Conwill

11. Encounter data standards: Implications for state Medicaid agencies and managed care entities from final Medicaid managed care rule, By Jeremy Cunningham, Maureen Tressel Lewis, and Paul R. Houchens

For a summary and link to all of the articles, click here.

Milliman Risk Talks: Healthcare dynamics and ERM (Part 2)

In this Milliman Risk Talks episode, Mark Stephens and Vikas Shah discuss the role of enterprise risk management (ERM) within the health insurance industry. They also provide perspective on the effect that the National Association of Insurance Commissioners (NAIC) Own Risk Solvency Assessment (ORSA) may have on health insurers. This is the second video in a two-part series on healthcare dynamics and ERM; the first video focused on risk management and healthcare delivery.

To watch our Milliman Risk Talks series, click here.

Milliman Risk Talks: Healthcare dynamics and ERM (Part 1)

In the latest episode of Milliman Risk Talks, Mark Stephens and Vikas Shah discuss how enterprise risk management (ERM) helps organizations navigating the changing dynamics of the healthcare industry. The first video in a two-part series focuses on healthcare delivery, offering a perspective on the state of risk intelligence for providers. Part two addresses the same topic but from the viewpoint of the ever-changing health insurance industry.

To watch our Milliman Risk Talks series, click here.

Another “Sharknado” could take the insurance industry by storm

Carbone-WilliamAccording to forecasts by the basic-cable network SyFy, a storm similar to the sharknado that hit Los Angeles last year is making its way toward the New York area. While AIR Worldwide estimated the losses from last year’s event at $100 billion, estimates for the impact on New York would heavily depend on the storm’s path. Let’s take a look at what impact the anticipated storm could have on the tristate area’s insurance market.

Is my property covered?
New York area homeowners should know that, much like the Los Angeles area residents, their policies will cover damage from windstorms, including tornados and hurricanes, subject to a windstorm deductible. These deductibles vary by policy and, more importantly, by region. Insureds in Tornado Alley will likely be subject to more significant windstorm restrictions, often needing a policy extension to ensure adequate coverage, while New Yorkers are more likely to have manageable windstorm deductibles since they are not as prone to these losses. The impact of windstorm deductibles on both an insured’s wallet and the insurer’s bottom line can be significant, depending on how a given storm is classified. In 2012, the use of executive orders and press releases to waive hurricane deductibles after Superstorm Sandy shifted a portion of the claim costs from the insureds to the insurer.

Fortunately for New York area residents, flying debris caused by windstorms is generally covered by homeowners policies. Similarly, comprehensive auto coverage would also cover physical damage that is due to debris from a windstorm. In this paragraph, “debris” can be read to mean “flying sharks.”  These coverages are important as a significant portion of the loss caused by tornadoes is due to flying debris damaging property that narrowly missed a direct hit, but was close enough to suffer the consequences.

Who pays the bills for shark attacks?
Health insurance policies cover attacks by animals, so New Yorkers can rest easy knowing their stitches will be covered. However, the tourist population should ensure that they have adequate visitors’ health insurance, as other countries’ universal healthcare policies do not apply here. Similarly, U.S. residents should check their health insurance policies before traveling abroad. Many health insurance policies operate differently for travelers abroad, and knowing what is covered in the case of a shark attack, or other medical emergency, could have a major financial impact.

For anyone keeping sharks as pets, you would be liable if a twister lifted your shark from your property and it were to bite a neighbor. Luckily your homeowners policy would cover this liability, assuming your specific shark was not an excluded breed. Many providers will deny coverage or alter policies for dog breeds considered “dangerous,” while other insurers will review dogs on a case-by-case basis. It can be assumed the same review would go into sharks kept as pets, so you may be covered for both your hammerhead and Labradoodle but not for your great white or Doberman.

Any new considerations
After seeing how the Los Angeles event ended, there are other possible implications in the New York insurance market that may come into play. It would be wise to review the intended uses on all recently purchased chainsaws, as many product warranty policies do not cover unintended uses, such as extraction from a shark torso. Additionally, the soft aviation market may need to harden a bit if helicopter pilots plan to help end a sharknado in the area. Last year’s storms ended when homemade bombs made out of kerosene containers were thrown from a helicopter into the twister, with the explosions equalizing the pressure. Without reviewing the underwriting, these types of flights are likely riskier than those anticipated in the standard policy.

With great white sightings on the rise in Cape Cod and a relatively rare Boston area tornado this week, a sharknado in the region appears possible. Luckily, it seems that most potential sources of loss for the average resident would be covered. Policy deductibles and exclusions may increase the final cost to insureds, but they likely won’t be footing the whole bill. It helps to know that the impact of a potential sharknado won’t take too big of a bite out of your wallet.

Will Carbone - Sharknado Picture

Will Carbone conducting research for this blog.