John Cookson

Principal, Consulting Actuary
Milliman
Biography

John is a principal with the Philadelphia office of Milliman. He joined the firm in 1973.

John’s areas of expertise include all aspects of group health insurance and statistical methods for solving actuarial problems. He has substantial experience in trend analysis and forecasting, dental insurance, stop loss, and risk analysis. He has also dealt extensively with clients’ market strategy problems. John has advised Blue Cross and Blue Shield plans, commercial insurers, HMOs, and PPOs.

John has experience working with large self funded employers in areas such as strategic planning, benefit design and pricing, IBNR, financial forecasting, establishment of contingency reserves, and catastrophic claims analysis.

John was the founder and publisher of the Milliman Health Cost Index™ – a proprietary index of medical cost trends. He has been involved in the transition of the Milliman Health Cost Index to the S&P Medical Trend Indices, and in the continued monitoring and development of S&P’s Indices. He developed the Hospital Efficiency Index™ – a method for evaluating the efficiency of hospital utilization, and was responsible for the initial development of Milliman’s Dental Cost Guidelines and Aggregate Stop Loss Net Claim Cost Guidelines.

John was a member of the 2010-2012 Medicare Trustees’ Technical Review Panel, which periodically reviews the assumptions and methods underlying the Medicare trustee’s short- and long-term projections of the Medicare program.

More recently, John has been involved in the development of simulation models used in the successful placement of a series of insurance linked securities tied to health insurance loss ratios (“cat bonds”). These models and the Health Cost Index also serve as a basis for Milliman’s work in risk-based capital models.

Author Archives: John Cookson

Impact of the Affordable Care Act (ACA) on Individual versus LG/ASO Trends

When we initiated our forecast on the S&P Healthcare Claims Indices in 2014, we wanted to avoid the effects of the ACA on individual and Small Group claim costs, so we focused on Large Group and Administrative Services Only (ASO) trends.  The individual claim costs continued to show a sharp divergence in trends from the Read more […]

Impact of the Affordable Care Act (ACA) on Total Business vs Total Business less Individual Market Trends

The chart below shows the history of the S&P Claims Based Indices trends for total business and also total business less individual.  Up until 2014 the total and the total less individual were generally within a half a percent or so on a three month moving average trend basis. However, with the advent of the Read more […]

Impact of the Affordable Care Act (ACA) on Enrollment

Given the sharp uptick in individual trends in 2014, which have peaked at 45% on a three-month moving basis, our operative scenario is that some of these new enrollees are crowding out care on the LG/ASO lines of business. The reason is that these new enrollees, many of whom have not had insurance and others Read more […]

Impact of the Affordable Care Act (ACA) on Individual versus LG/ASO Trends

When we initiated our forecast on the S&P Claims Based Indices late in 2014 we wanted to avoid the effects of the ACA on individual and small group claim costs so we focused our models on the LG/ASO lines of business. Clearly, the 2014 experience on individual shows a sharp divergence in trends from the Read more […]

Observations on January Release of S&P Claims Based Indices (Allowed Charge Trends): Part 4

The overall medical trend rates covering all services have continued to be modest in the S&P data through the 3rd quarter of 2014—increasing up to 3.5% on a 12-month moving average basis as of September[1]. But the winter of 2014 was particularly harsh in much of the country and likely dampened utilization.  Late fall 2014 Read more […]

Observations on January Release of S&P Claims Based Indices (Allowed Charge Trends): Part 3

The overall medical trend rates covering all services have continued to be modest in the S&P data through the 3rd quarter of 2014—increasing up to 3.5% on a 12-month moving average basis as of September[1]. But in 2014 the Individual trends reported by S&P are now over 45% based on 3-month moving average trends as Read more […]

Observations on January Release of S&P Claims Based Indices (Allowed Charge Trends): Part 2

Although the overall medical trend rates covering all services have continued to be modest in the S&P data through the 3rd quarter of 2014[1],  the prescription drug trends have been more volatile but modest prior to mid-2013, but have continued to accelerate since then through September 2014.  On a 3-month basis they have climbed to Read more […]

Observations on January Release of S&P Claims Based Indices (Allowed Charge Trends): Part 1

The overall medical trend rates covering all services have continued to be modest in the S&P data through the 3rd quarter of 2014—increasing up to 3.5% on a 12-month moving average basis as of September[1]. Milliman uses the S&P claims based indices to create a Health Cost Index Claims Based Forecast that uses economic factors Read more […]