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Mitigating the impact of high-cost claimants: A payer analytics approach to total cost of care
It has long been understood that a relatively small portion of any covered population accounts for a disproportionately large share of healthcare spending. A 2025 study by the Employee Benefit Research Institute (EBRI), which examined 13.1 million individuals with employer-sponsored health coverage in 2022, found that the highest-cost 20% of members were responsible for 84% … Mitigating the impact of high-cost claimants: A payer analytics approach to total cost of care
Why VBC still fails for mature organizations: What actually separates high performers
Value-based care (VBC) has moved well beyond experimentation. For many healthcare organizations, value-based contracts now represent a significant share of revenue, risk exposure, and strategic focus. The industry has largely resolved the question of whether to participate in these models. What remains unresolved is how to manage them most effectively. Increasingly, a common source of … Why VBC still fails for mature organizations: What actually separates high performers
CJR-X starts January 2028. The hospitals that win are starting now
CMS has finalized the first nationwide expansion of an episode-based payment model, and by its own account the largest such model in Medicare’s history: a mandatory program covering lower extremity joint replacements (LEJR). It is called CJR-X, short for Comprehensive Care for Joint Replacement Expanded, and it begins January 1, 2028, as an ongoing program … CJR-X starts January 2028. The hospitals that win are starting now
Turn total cost of care strategy into measurable action
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 … Turn total cost of care strategy into measurable action
The decade of full risk starts now: Four workflows separate ACOs ready for it
The conditions for value-based care (VBC) have just shifted, as stronger financial results, improved data usability, and new long-term CMS incentives reshape what it takes for Accountable Care Organizations (ACOs) to compete and succeed. ACOs have had access to Centers for Medicare & Medicaid Services (CMS) claims data for years. What has made the difference … The decade of full risk starts now: Four workflows separate ACOs ready for it
Healthcare payer analytics: Challenges, findings, and next steps
Health plans are investing heavily in analytics and artificial intelligence (AI) but are they getting the results they need? That was the central question at Milliman MedInsight’s June 18th webinar: Data-Driven Payer Strategies: Survey Insights and Solutions. Presenters Marcos Dachary (Milliman MedInsight Principal, Chief Market Strategist and General Manager of Payer Solutions), Lauren Piacentini (Milliman … Healthcare payer analytics: Challenges, findings, and next steps
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THMA Fall 2026 Value-Based Strategy Collaborative
Milliman MedInsight is headed to Washington, D.C. for the The Health Management Academy’s Fall 2026 Value-Based Strategy Collaborative, an invitation-only gathering of senior health system and industry executives focused on advancing value-based care strategy through peer discussion, shared strategy, and practical insight. At this year’s collaborative, we look forward to connecting with leaders across managed … THMA Fall 2026 Value-Based Strategy Collaborative
Healthcare Analytics: 2026 in Review and What’s Ahead for 2027
As 2026 comes to a close, healthcare organizations are navigating a rapidly evolving analytics landscape marked by both significant opportunities and complex challenges. The accelerated experimentation and adoption of AI-driven technologies is transforming how healthcare organizations approach strategy and decision-making, underscoring the critical importance of investing not only in AI capabilities, but also in the trusted, high-quality data … Healthcare Analytics: 2026 in Review and What’s Ahead for 2027
Milliman HealthVision360 2026
Navigating Healthcare Complexity and Creating Solutions Together Healthcare leaders are facing unprecedented pressure to improve outcomes, control costs, adapt to changing regulations, and make critical decisions with confidence. At Milliman HealthVision360, you’ll gain practical strategies, industry insights, and peer connections designed to help your organization move from complexity to clarity. Join health plan, provider, and … Milliman HealthVision360 2026
Will you succeed in CJR-X and TEAM? How to build a CMS-aligned view of your bundled payments
With Comprehensive Care for Joint Replacement Expanded (CJR-X) set to launch January 2028, every eligible acute care hospital in the country is facing a new reality: mandatory bundled payments across a full 90-day episode window for joint replacement procedures. This is part of a broader and accelerating shift — CMS already made bundled payments mandatory … Will you succeed in CJR-X and TEAM? How to build a CMS-aligned view of your bundled payments
Epic UGM 2026
Step right up for a higher view of value-based care Meet Milliman MedInsight at Epic UGM 2026. The midway is loud, fast, and full of distractions – and so is value-based care. This year at Epic’s Meet at the Midway gathering, Milliman MedInsight (MedInsight) is bringing the one thing every organization needs to come out … Epic UGM 2026
Mitigating the impact of high-cost claimants: A payer analytics approach to total cost of care
It has long been understood that a relatively small portion of any covered population accounts for a disproportionately large share of healthcare spending. A 2025 study by the Employee Benefit Research Institute (EBRI), which examined 13.1 million individuals with employer-sponsored health coverage in 2022, found that the highest-cost 20% of members were responsible for 84% … Mitigating the impact of high-cost claimants: A payer analytics approach to total cost of care
