Benefits of MedInsight
Provider Performance
- Track and measure provider performance variation
- Engage providers with real-time performance data
- Identify providers who excel in cost efficiency, quality, and appropriateness of care
- Share actionable next steps to close care and coding gaps, and reduce unnecessary cost
Achieving value-based care (VBC) success requires more than good intentions. It demands a clear alignment between physician performance and organizational goals that prioritize better patient experiences, healthier communities, and efficient resource use. Yet, persistent gaps in preventive care, operational inefficiencies, and unclear expectations can stall progress and lead to inconsistent outcomes. Consistent, practical, and fair assessment of provider performance is essential for building trust, managing costs, and delivering high-quality care.
Why provider performance measurement is essential
For healthcare organizations, tracking provider performance is crucial to remain competitive and advance VBC initiatives. Reliable insights into provider performance enable organizations to guide patients to quality care, strengthen their networks, and negotiate more effectively. When care quality and efficiency vary across a network, both patients and organizations are at risk. Without clear standards and reliable evaluation, patients may miss recommended care, and providers may lack the direction needed to succeed in value-based contracts.
Performance measurement helps organizations:
- Identify areas for improvement: Pinpoint care gaps and monitor adherence to clinical guidelines.
- Strengthen network performance: Aggregate data at provider, group, and network levels for a holistic view.
- Provide cost-effective, high-quality care: Track costs, utilization, and outcomes, using fair, risk-adjusted benchmarks.
Consistent and trustworthy data fosters confidence, drives collaboration, and aligns stakeholders toward shared goals.
Provider performance data empowers organizations to:
- Drive quality improvement and close care gaps
- Link incentives to quality, cost, and risk metrics
- Identify top performers and spread best practices
- Optimize network management and adequacy
- Monitor resource use and reduce inefficiencies
- Automate regulatory reporting and compliance
- Support patient attribution and care coordination
- Engage providers with clear, actionable feedback
Integrated solutions for deeper insights
MedInsight’s comprehensive approach enables seamless access to specialized tools for every stage of provider and network management:
- VBC Platform: Evaluate provider effectiveness, manage risk, and optimize outcomes for attributed populations.
- ACO Builder: Identify top-performing providers, assess readiness for value-based models, and align organizational goals.
- Benchmarks: Compare your organization’s and providers’ performance with national and regional standards to set realistic targets, measure progress, and drive continuous improvement.
- Episode grouping: Identify how efficient a provider is in delivering episodes of care compared to other providers within your population.
- Evidence-based Measures (EBMs): Apply EBM measures to provide actionable insights that support provider performance improvement, ensuring care aligns with the latest clinical guidelines and best practices.
- MARA (Milliman Advanced Risk Adjuster): Leverage advanced risk adjustment analytics with MARA to ensure fair provider comparisons, support equitable performance measurement, and optimize reimbursement in VBC arrangements.
- HCC (Hierarchical Condition Categories): Enhance risk adjustment for provider populations with powerful HCC analytics and coding accuracy tools that help you close documentation gaps and maximize performance.
Transform provider performance with confidence
With MedInsight, healthcare organizations gain access to robust data and sophisticated analytics, empowering them to effectively monitor, measure, and enhance provider performance. This drives improved patient outcomes and supports long-term success in VBC initiatives.
Relevant resources
The intersection of clinical data integration and value-based care: Strategies for success
Electronic Health Record (EHR) systems have transformed healthcare by simplifying access to patient data. Their true value emerges when clinical EHR data is integrated with medical claims data, enabling better care coordination, improved quality, and lower costs—key goals of value-based care. Yet, integration remains challenging due to system fragmentation, data silos, inconsistencies, and delays, all … The intersection of clinical data integration and value-based care: Strategies for success
Building transparency: Best practices for optimizing value-based performance reporting
Transparency plays a crucial role in value-based performance (VBP) reporting. It ensures accountability and trust between health plans and healthcare providers. In a system where outcomes matter, clear reporting fosters better decision-making and collaboration, increasing stakeholders’ commitment to quality care. In this blog post, Milliman MedInsight Marketing Director Sarah Quinn explains the role of technology … Building transparency: Best practices for optimizing value-based performance reporting
How does clinical data integration drive value-based care? Lessons learned from leading health systems
Join us as we unravel the significance of clinical data integration, drawing insights from leading health systems that have successfully harnessed both claims and clinical data to advance their value-based care priorities. Discover the lessons learned and best practices in leveraging integrated data for informed decision-making, improved patient outcomes, and enhanced value-based care strategies. Whether … How does clinical data integration drive value-based care? Lessons learned from leading health systems
DVACO: The power of data organization and standardization
The Delaware Valley Accountable Care Organization (DVACO) aims to deliver better healthcare at a lower cost to around 250,000 members in the Greater Philadelphia region. DVACO is currently the region’s largest ACO, with more than 2,000 primary care physicians and 250,000 attributed patients. DVACO participates in the Medicare MSSP program, and six additional risk-based contracts … DVACO: The power of data organization and standardization
