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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
MA Plan identifies hidden cost drivers and recovers millions through deeper inpatient cost transparency
When a Midwest provider of MA plans was facing mounting costs that its legacy analytics capabilities could not explain, the organization sought help with analyzing utilization costs by facility, market and product, and surfacing trends and insights that could identify cost-saving opportunities. Without the ability to drill down into cost drivers, the unjustifiably high acuity … MA Plan identifies hidden cost drivers and recovers millions through deeper inpatient cost transparency
Research hospital executes a challenging shift to more cost-effective clinical care
When one of the country’s flagship research hospitals sought to shift from high-cost academic work to more cost-effective and sustainable clinical care, the organization began a restructuring designed to improve clinical and financial outcomes in its population of approximately 645,000 at-risk patients, with a focus on the Medicare Shared Savings Program (MSSP) and Medicaid. To … Research hospital executes a challenging shift to more cost-effective clinical care
New report shows how healthcare payers are using analytics and AI to drive impact
Healthcare payers are making big investments in analytics, AI, and digital transformation with the goal of translating data into bottom line efficiencies and improved member experiences. For many payers, however, system integration, staffing, and improved data quality are needed to fully translate analytics investments into the operational gains they are seeking. Those are among the … New report shows how healthcare payers are using analytics and AI to drive impact
Beyond the model: How leading organizations will win under CMS LEAD RFA
A recap of our May 7 webinar If you missed our live session, “How leading organizations will win under CMS LEAD RFA,” don’t worry. My colleague Jonah Broulette, Principal and Consulting Actuary at Milliman, and I walked our audience through what’s actually new in CMS’s LEAD model, how it stacks up against MSSP, and the … Beyond the model: How leading organizations will win under CMS LEAD RFA
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Milliman MedInsight ACO clients achieve $658 million in savings, outperforming national averages in the 2024 Medicare Shared Savings Program
Seattle, WA — Thursday, Oct. 2 — Milliman MedInsight® (MedInsight), a leading healthcare data and analytics division of Milliman, announced that its Accountable Care Organization (ACO) clients delivered exceptional results in the 2024 Medicare Shared Savings Program (MSSP), according to preliminary data released by the Centers for Medicare & Medicaid Services (CMS). In 2024, MedInsight … Milliman MedInsight ACO clients achieve $658 million in savings, outperforming national averages in the 2024 Medicare Shared Savings Program
Optimizing outcomes: Leveraging analytics for provider performance in value-based care
In a recent webinar discussion, Milliman MedInsight and Genesys PHO explored how healthcare organizations can use performance analytics to strengthen value-based care (VBC) initiatives. The panel included Francesca Hammerstrom, General Manager of Value-Based Care at Milliman MedInsight; Dr. Christopher Kodama, Chief Medical Officer at Milliman MedInsight; Samantha Lewis, Director of Healthcare Business and Population Health … Optimizing outcomes: Leveraging analytics for provider performance in value-based care
Charting new frontiers with generative AI: A MedInsight journey
In recent years, generative artificial intelligence (Gen AI) has progressed far beyond being an industry buzzword—it’s now a driving force reshaping how organizations collect, analyze, and utilize data for optimizing patient care and organizational strategy. The transformative potential of Gen AI, particularly in the realm of healthcare analytics, cannot be overstated. As healthcare organizations grapple … Charting new frontiers with generative AI: A MedInsight journey
Milliman MedInsight announces expanded capabilities with the launch of the Innovation Portal, an AI-powered cloud analytics platform for healthcare organizations
Seattle, WA – Sept. 8, 2025 – Milliman MedInsight®, a division of Milliman and leading provider of healthcare data and analytics, proudly announces the launch of the MedInsight Innovation Portal, the next-generation of its Data Science Portal (DSP). Purpose-built for healthcare organizations navigating increasingly complex environments, the MedInsight Innovation Portal delivers powerful new capabilities, intuitive … Milliman MedInsight announces expanded capabilities with the launch of the Innovation Portal, an AI-powered cloud analytics platform for healthcare organizations
Risk Adjustment Services for MA Plans
Medicare Advantage (MA) plans face challenges in accurately assessing and managing member health risks, especially as regulations and CMS guidelines change. To ensure fair reimbursement and stay competitive, MA plans need strong risk adjustment strategies and precise documentation of Hierarchical Condition Categories (HCCs), since mistakes can lead to compliance issues and lost revenue. They also … Risk Adjustment Services for MA Plans
Advancing pharmacy management: The impact of biologics, biosimilars, GLP-1s, and data-driven insights
Healthcare costs continue to climb with the average per-person expense rising 6.7%—from $7,378 in 2024 to $7,871 in 2025. This increase is being driven primarily by two categories: pharmacy and outpatient facility care. Pharmacy costs alone grew by 9.7%, while outpatient facility care costs have risen by 8.5%. Collectively, these service areas are responsible for … Advancing pharmacy management: The impact of biologics, biosimilars, GLP-1s, and data-driven insights
