Value-based care (VBC) shifts the focus from the quantity of healthcare services delivered to the quality and effectiveness of care provided. In this model, providers are rewarded for improving patient outcomes, enhancing care efficiency, and refining resource use. This shift matters because it aligns incentives with what truly benefits patients: better health, the right amount of care, and more coordinated services.
For organizations moving toward VBC, the ability to make informed decisions based on reliable, comprehensive data becomes critical. Accurate data enables providers to identify strengths, pinpoint areas for improvement, and take targeted action to achieve better results. Without this insight, it is difficult to measure progress or understand the true impact of care initiatives.
While every organization’s VBC journey is unique, we’ve observed a common progression in how capabilities develop over time. The steps outlined here are not a rigid formula, but rather the most frequent stages organizations move through as they build the skills, infrastructure, and confidence needed to manage populations effectively. Your path may vary, but these patterns offer a useful framework for thinking about how to evolve your VBC strategy.
Milliman MedInsight® (MedInsight) offers a scalable, data-driven analytics platform designed to support organizations at every stage of their VBC journey. Whether an organization is just beginning to explore value-based models or is managing advanced contracts with significant financial risk, the MedInsight VBC Platform delivers the insights needed to guide strategy, monitor performance, and drive improvement. As needs evolve, the platform adapts, offering deeper analysis, more sophisticated forecasting, and actionable intelligence. With MedInsight, healthcare organizations can confidently navigate the complexities of VBC and achieve measurable, sustainable outcomes.
Step 1: A common first step — start small with bundled payments to build VBC experience
For many healthcare organizations, the first move into VBC is to pilot contained tests of change, initiatives that allow teams to learn and build capabilities before taking on greater financial risk. These may include piloting a contract with a single payer, designing care delivery with embedded services, or, most commonly, launching a bundled payment program.
Bundled payment models offer a lower-risk entry point. Providers share in savings when episode costs fall below a target price, and depending on the arrangement, may incur penalties if costs exceed the target. This structure helps organizations develop skills in cost management and care coordination, often with limited or delayed downside exposure, while gradually preparing them for more advanced risk-based models.
Achieving success requires more than standard reporting: it demands bundled payment-specific analytics to pinpoint cost drivers, track episode characteristics, and benchmark performance.
The MedInsight Bundles application meets these needs by processing detailed claims data to deliver actionable insights into episode costs and utilization patterns compared to benchmarks. Organizations can track performance trends over time, analyze variation in care delivery, and identify opportunities for improvement using reliable, industry-standard benchmarks.
In addition to performance measurement, MedInsight Bundles supports contract management and program implementation with transparent, customizable reporting that aligns with the requirements of various models including the Enhancing Oncology Model (EOM) and the Transforming Episode Accountability Model (TEAM). With these capabilities, healthcare organizations can make informed, data-driven decisions, improve care coordination, and strengthen their position for future success, building the foundation for taking on greater financial responsibility in the next stages of their VBC journey.
Step 2: Move to ACOs with data-driven modeling & network design
After gaining experience in early shared-risk models with limited downside exposure, many organizations progress to arrangements with greater levels of both upside- and downside-risk, such as the Medicare Shared Savings Program (MSSP) or ACO REACH. This transition expands the scope of responsibility from managing discrete episodes of care to overseeing the health and costs of an entire patient population. Success at this stage depends on making informed decisions about contract participation, financial risk, and network composition.
To prepare, organizations must evaluate contract options, model financial outcomes, assess provider performance, and design networks capable of delivering both high-quality care and cost efficiency.
Milliman ACO Builder® quantifies provider-level performance both inside and outside of a Medicare ACO to identify the best-performing providers. The tool was developed to help organizations meet the need for pinpointing high-value providers and performance patterns. Leveraging comprehensive Medicare claims and eligibility data, it delivers detailed analysis at the provider, network, and organizational levels.
Core capabilities of ACO Builder are delivered through three modules:
- Explorer delivers deep insights into provider performance, costs, utilization patterns, and care gaps to pinpoint opportunities for improvement.
- Forecast enables modeling of various provider combinations and contract terms to produce accurate financial projections for strategic planning.
- Opportunity benchmarks providers against regional and national standards, supporting network optimization and informed participant selection.
Together, these capabilities equip organizations to design high-performing ACO networks, evaluate potential risk arrangements, and enter accountable care with confidence. By building on the analytical foundation established in bundled payment programs, organizations can manage larger populations, align incentives across providers, and position themselves for greater success in advanced value-based models.
Step 3: Manage early shared risk with ready-to-use analytics
As a contract begins, the ACO must do the work of improving quality care while reducing total cost of care. Early ACOs are often supported by small analyst teams and must balance growing data needs with limited resources. Larger organizations face a different challenge: meeting the demands of many information consumers across clinical, operational, and financial teams. In both cases, success depends on having packaged analytics that address standard ACO requirements, combined with intuitive tools that make performance monitoring efficient.
The MedInsight VBC Insights application is designed for this phase. It delivers comprehensive, actionable analytics in an accessible format, serving as a single source of reliable data for all stakeholders. This unified approach streamlines performance tracking and ensures teams work from the same trusted information.
Key capabilities include:
- Risk- and demographic-adjusted benchmarks for meaningful comparisons.
- Dashboards and reports to track cost drivers, utilization trends, and quality measures over time.
- Patient population stratification to prioritize outreach and care management.
- Provider profiling to assess performance and drive accountability.
- Network leakage analysis to address out-of-network care that impacts cost and quality.
With these tools, organizations of any size, from lean early-stage teams to established ACOs with multiple contracts, can manage shared-risk arrangements, identify opportunities for cost savings and quality improvement, and prepare for greater financial responsibility. VBC Insights enables a transition from cautious participation to confident, data-driven leadership in VBC.
Step 4: Navigate complex business questions & contracts with an integrated VBC Platform
In the advanced stage of their journey, ACOs may oversee multiple risk contracts spanning large, diverse patient populations, increasing their exposure to financial risk. Achieving VBC goals at this point requires integrating vast data sets, managing complex financial arrangements, and coordinating care across an extensive provider network.
The MedInsight VBC Platform supports these needs through three integrated applications: VBC Insights, VBC Analytics, and VBC Contracts.
- VBC Insights delivers timely, actionable information to stakeholders by synthesizing the “what” (data content) and the “who” (populations/providers) to explain the “why” behind performance trends, and, critically, the “how” to improve them. Drawing from monthly data feeds and Claim and Claim Line Feed (CCLF) files, it produces comprehensive reports using Milliman-developed benchmarks for more than 80 service categories, including detailed post-acute service benchmarks by diagnosis-related group (DRG). Beyond identifying trends, VBC Insights pinpoints the highest-yield opportunities for action, such as reducing avoidable utilization, improving care transitions, or closing quality gaps, giving ACOs a clear roadmap to strengthen contract performance and advance population health goals.
- VBC Analytics enables deeper exploration of the “what,” “who,” and “why” through highly customizable analyses. Tools such as Cube Browser and Query Express empower advanced users to conduct in-depth benchmarking, identify performance gaps, and perform root-cause analysis to guide strategic decisions In addition, users can quickly generate standard reports from pre-built templates or easily create customized reports using our intuitive drag-and-drop functionality, making powerful insights accessible to both advanced analysts and everyday users.
- VBC Contracts centralizes all value-based payment agreements in one place, bringing the “what” and “who” together for contract-specific oversight. Users can model contract performance, set individualized targets, and track progress through interactive dashboards, ensuring alignment between operational performance and financial goals. The platform enables monitoring of contract performance across all lines of business, whether in aggregate, at the individual contract level, or through customized groupings, providing a comprehensive and flexible view to inform strategic decision-making.
By integrating these capabilities, the MedInsight VBC Platform equips mature ACOs to efficiently manage complex risk arrangements, optimize outcomes across multiple contracts, and sustain long-term success in VBC.
Step 5: Lead the market with innovation & advanced capabilities
At the highest level, leading ACOs manage multiple complex risk contracts for large, diverse populations. Success here means finding opportunities faster, making confident decisions across the organization, and continuously improving both cost and quality outcomes.
The MedInsight Innovation Portal enables this by putting powerful insights directly into the hands of decision-makers. It gives everyone, from executives to care managers to analysts — secure, immediate access to enriched claims data, market intelligence, and customizable datasets. Its intuitive, user-friendly design democratizes data access, so even non-technical users can explore trends, answer questions in plain language, and act on timely intelligence.
For technical teams, the Innovation Portal offers advanced capabilities to go deeper: seamless integration with popular BI tools, automation that reduces dependence on IT, and an environment for building, deploying, and scaling AI and machine learning models using R, Python, or SQL. Pre-built models, customizable analytics, and collaborative features accelerate the journey from raw data to actionable insight.
By combining accessible design with cutting-edge analytics, the Innovation Portal empowers leading ACOs to innovate more quickly, evaluate performance with greater precision, and uncover new opportunities for efficiency and quality improvement. This balanced approach supports operational excellence today, and positions organizations to shape the future of their VBC contracts.
The Milliman MedInsight advantage: Proven support at every stage of value-based care
With over 300 clients, including 20 percent of the ACO market, and more than 20 years of healthcare analytics expertise, Milliman MedInsight helps organizations excel at every stage of the VBC journey. From contained tests of change like bundled payments to complex multi-contract risk arrangements, our scalable, modular analytics suite delivers reliable data, industry benchmarks, and actionable insights to improve quality, reduce costs, and enhance efficiency. Our approach is designed to partner with you in achieving your goals – no matter where you are on your VBC journey.
With MedInsight, your ACO can:
- Save valuable staff time by eliminating manual data cleanup and using Milliman’s streamlined analytics and data integration.
- Strengthen analysis with advanced clinical and financial tools plus peer-matched benchmarks for deeper, actionable insights.
- Rely on a single, consistent source of truth by bringing clinical and claims data together in one unified model.
Designed for cloud adoption and seamless integration, MedInsight empowers healthcare leaders to make informed decisions and drive continuous improvement.
Additional resources on our VBC solutions
Download our VBC Platform brochure to learn more
Download our VBC Insights brochure to learn more
Download our eBook: The intersection of clinical data integration and value-based care: Strategies for success
Read our blog post: Navigating value-based care in 2025: How to implement it successfully in your practice
Ready to advance your VBC strategy?
Request a personalized demo or schedule a free readiness assessment to discover how MedInsight can help you achieve measurable results and long-term success.
