Network medical cost evaluations

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Milliman is a market leader in performing medical network evaluations. Differences in negotiated reimbursement have a significant impact on a self-insured employer’s healthcare spend.

Since provider contracts are frequently re-negotiated, carrier market rankings will fluctuate. Employers should review carrier discount rankings every couple of years to ensure they are with the most competitive network from a discount perspective. At Milliman, we leverage our expertise in data handling with best practice standards to assist our clients in making informed financial decisions.

Industry experience

Milliman facilitates the Uniform Data Standards (UDS) workgroup that sets the guidelines for consultant data submissions and discount calculations. This group was established in 2007 and provides guidance for consistent and fair comparisons. In addition to UDS, we have performed network evaluations for thousands of employers, ranging in size from Fortune 500 companies to local employers.

Employer-focused approach

Many discount studies in the marketplace rely simply on the employer’s census to weight carrier book-of-business discounts. Milliman utilizes multiple methods for helping our clients by identifying the optimal approach based on needs and timing.

We will take a deeper dive by using actual employer claims experience, which reflects the group’s mix of providers and services. This type of analysis provides a more accurate measurement of the financial impact of a network change. We also factor in provider disruption to model the impact if a network change is made. Milliman’s expansive industry knowledge, our expertise and efficiencies in handling data, and our independence make us a clear choice in analyzing cost differentials under alternative networks.

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