Top 15 global articles and reports for 2017

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In 2017, the majority of the most popular articles published on our website related to healthcare and pensions. Potential healthcare reform sparked a flurry of papers from Milliman consultants, and seven healthcare articles made the top 15 list. But other articles—including on the rise of InsurTech and the challenges of IFRS 17—managed to crack the list of the most popular articles for the year. Below is a list of the top 15 articles worldwide for 2017.


Milliman Medical Index, By Christopher Girod, Susan Hart, and Scott Weltz

In 2017, the cost of healthcare for a typical American family of four covered by an average employer-sponsored preferred provider organization plan is $26,944, according to the Milliman Medical Index.


Pension Funding Index, By Zorast Wadia and Charles Clark

Monthly reports on the funded status of the 100 largest corporate defined benefit pension plans as measured by the Milliman 100 Pension Funding Index.

The most recent Pension Funding Index indicates that with only one month left in 2017, the funded ratio for the Milliman 100 plans is on track to exceed that of 2016, with strong double-digit returns for the year (barring an exceptional event).


Corporate Pension Funding Study, By Zorast Wadia, Alan Perry, and Charles Clark

The 100 largest corporate defined benefit pension plans finished 2016 with pension assets of $1.395 trillion and projected benefit obligations of $1.718 trillion.


Impact of the transition from RAPS to EDS on Medicare Advantage risk scores, By Deana Bell, David Koenig, and Charlie Mills

A study of how the transition from Risk Adjustment Processing System data to Encounter Data System (EDS) data is affecting the payment year 2016 risk scores and revenue for Medicare Advantage, also known as Medicare Part C.

The paper found that the transition to EDS-based risk scores will have a significant effect on Medicare Advantage organizations in payment year 2016 and future years.


Summary of individual market enrollment and Affordable Care Act subsidies, By Paul Houchens, Jason Clarkson, and Zachary Fohl

A profile of the individual health insurance market for each state along with the District of Columbia, summarizing insurer financials, marketplace enrollment, and federal assistance provided to households purchasing insurance coverage through the insurance marketplaces, incorporating recently released data from the 2017 open enrollment period.


2017 Public Pension Funding Study, By Rebecca Sielman

An annual exploration of the funded status of the 100 largest U.S. public pension plans.

The study found that as of June 30, 2017, the aggregate funded ratio is estimated to be 70.7%, as assets experienced healthy growth. It also found that one-third of the plans reduced the interest rate assumptions they use for determining contribution amounts.

Figure 1: Aggregate system-reported funded status ($ trillions)

Note: The plan liability amounts from the 2014 and 2015 studies are the accrued liability used for determining contribution amounts; the 2016 and 2017 studies report the GASB 67/68 Total Pension Liability.


The employer stop-loss insurance marketplace since the Affordable Care Act, By Mehb Khoja

The Patient Protection and Affordable Care Act has considerably increased the need for and expanded employer interest in stop-loss coverage due to several factors, including the removal of annual and lifetime maximums and the removal of pre-existing condition exclusions, among others.


InsurTech: Innovation in the P&C insurance space, By Thomas Ryan

While the number of InsurTech deals may have peaked in the first quarter of 2016 (59 deals for $783 million), the market still appears to be very active (38 deals for $283 million in the first quarter of 2017). To determine what may be the hype curve for InsurTech, it’s valuable to pause and survey the current landscape.


Overview and practical considerations of the new insurance contract standard: IFRS 17, By Gillian Tucker and Andrew Kay

This briefing note discusses some of the challenges companies will face when adopting and applying IFRS 17.


Building blocks: Block grants, per capita caps, and Medicaid reform, By Justin Birrell, Jennifer Gerstorff, Nicholas Johnson, and Brad Armstrong

While a main topic in news discussions has been proposed reforms to health insurance exchanges created by the Patient Protection and Affordable Care Act, Medicaid reform has the potential to affect more people than any other source of coverage. Understanding the implications of Republican Medicaid reform proposals requires consideration of several factors.

Figure 2: Potential risk by funding source

Funding scenarios
Funding attribute Current Block grant Per capita cap
Funding limit None, as long as regulatory requirements are met. Established in advance, unchanged with population growth or environmental factors. Established in advance, varies based on population size, but unchanged for environmental factors.
State vs. federal medical growth rate Consistent growth rates. Federal growth defined in advance. State growth leveraged based on overall growth. Federal growth is mitigated. State growth may be leveraged if cost per enrollee is more than projected.
Enrollment mix change risk Federal risk varies by FMAP: if populations with higher federal match increase at a faster rate than the overall population, state share of bill is lower. For states with low/no expansion enrollment, match is relatively steady. Federal government transfers risk to states. Depends on structure. If cap is per capita on an aid category basis, then risk is similar to current. If not based on aid category, mix of members by aid category could negatively impact states as population groups age and LTSS become more prevalent.
Enrollment growth mix Consistent risk state versus federal. Federal government transfers risk to states. Consistent risk state versus federal, as long as new members don't have higher-than-average cost.

Effective employee communication: The benefits of best practices, By Jessica Gonchar, Heidi tenBroek, and Sharon Stocker

Communications is vital to inform and influence how employees think about their benefits, workplace, and employer.


MACRA and Medicare Advantage plans: Synergies and potential opportunities, By Christopher Kunkel, Drew Osborne, Lynn Dong, Michael Polakowski, Noah Champagne, and Charlie Mills

While MACRA primarily affects Part B clinicians, there are numerous implications, synergies, and opportunities for Medicare Advantage plans.

Figure 1 – 2015 Medicare expenditures


The American Health Care Act, By Jason Karcher

The American Health Care Act would impose several reforms on the commercial market, repeal several taxes introduced under the Patient Protection and Affordable Care Act, and fundamentally reform the Medicaid funding process while allowing a glide path for the end of enhanced federal funding for the Medicaid expansion.


Multiemployer Pension Funding Study, By Kevin Campe

This study updates the estimated funded status of all U.S. multiemployer plans as of June 30, 2017, showing the change in funding levels from December 31, 2016. Among the findings from the study is that multiemployer plan funding as of June 30 is nearing its best position since the market collapse of 2008.

Figure 2: Aggregate multiemployer plan historical funded percentage – market value basis


MACRA: Key Considerations for health plans, By Colleen Norris and Mary van der Heijde

The Medicare Access and CHIP Reauthorization Act of 2015 represents a tectonic shift in how providers are reimbursed for the services they provide to Medicare fee-for-service beneficiaries.

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