Key Highlights
- A finance-ready analytics platform aligned with actuarial PMPMs, live in about six weeks
- A repeatable monthly governance process that turns analytics into activation
- Finance-validated savings measurement that strengthened internal trust and accountability
- Early identification of spend hotspots through benchmarking and deep drill-downs
Healthcare payers are under growing pressure to reduce costs while managing rising utilization, unit cost, pharmacy spend, and medical expense trends. But analytics alone are not enough. To create measurable impact, health plans need trusted data, actuarial alignment, enterprise governance, and a repeatable process for turning insights into action.
In this case study, see how a health plan serving millions across the East Coast partnered with Milliman MedInsight® to strengthen its Total Cost of Care (TCOC) strategy and build a scalable payer analytics foundation for enterprise-wide cost transformation.
How they took action
Find out how an East Coast health plan turned its Total Cost of Care (TCOC) strategy into scalable cost transformation by:
- Launching a trusted payer analytics platform aligned with actuarial PMPMs
- Using benchmarking and drill-down analytics to identify emerging spend hotspots
- Building a repeatable governance process to move opportunities from insight to activation
- Strengthening internal accountability with finance-backed savings measurement
- Expanding a cost-of-care culture across clinical, pharmacy, network, finance, and operational teams
- Creating a scalable analytics foundation for future value-based care and employer reporting use cases
Results: a clear before-and-after
Before
- ■Strong analytics, but insights weren’t consistently turning into measurable action
- ■Recurring “is the data right?” debates slowed decisions
- ■Thin margins — about 85¢ of every premium dollar goes to medical expense — left little room for error
After
- ■A trusted payer analytics platform aligned with actuarial PMPMs, live in about six weeks
- ■A monthly cost-of-care governance cadence that moves every opportunity from insight to activation
- ■Finance-validated savings measurement that built internal trust and accountability
- ■Early identification of spend hotspots through benchmarking and DRG-to-member drill-downs
- ■A cost-of-care culture spanning clinical, pharmacy, network, finance, and operations
Access the full case study
See how one health plan turned Total Cost of Care (TCOC) analytics into a durable enterprise capability.
