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From readiness to reality: What TEAM’s first year is really testing
In January 2026, CMS’s Transforming Episode Accountability Model (TEAM) moved from policy to practice. For hospitals in mandatory regions, TEAM is no longer something to prepare for on paper; it is live, operational, and beginning to influence how episode performance is evaluated clinically, financially, and operationally. Many organizations are entering 2026 with a measured posture. … From readiness to reality: What TEAM’s first year is really testing
Medicare Advantage 2026: Breaking down the new risk model and its impact in plain terms
The Centers for Medicare & Medicaid Services (CMS) introduced CMS-HCC Version 28 (V28) in 2024 as the next evolution of Medicare Advantage (MA) risk adjustment. For many organizations, the “new CMS-HCC model” felt more theoretical than operational, something plans were preparing for but not fully experiencing. That changes in 2026, when V28 becomes operational at … Medicare Advantage 2026: Breaking down the new risk model and its impact in plain terms
How CareFirst BlueCross BlueShield modernized analytics to cut cost of care
Health plans are walking a tightrope. On one side, utilization is climbing and breakthrough therapies, while clinically promising, are reshaping cost curves. On the other hand, members, employers, and providers expect more convenience, transparency, and value. The mandate is clear: deliver better outcomes and experiences without sacrificing affordability. Meeting that mandate requires more than more … How CareFirst BlueCross BlueShield modernized analytics to cut cost of care
Physician performance enablement: Engaging providers with actionable insights for ACO success
Many organizations now have access to more data than ever before, yet they often struggle to transform this information into practical actions that lead to real improvements in population health. Physicians play a vital role in this process and should be involved early when turning data into meaningful insights that are practical, effective, and aligned … Physician performance enablement: Engaging providers with actionable insights for ACO success
HIMSS26: From data foundations to operational execution in healthcare AI
The HIMSS Global Health Conference and Exhibition has long served as a signal for where healthcare technology is headed. This year’s conference, attended by more than 24,000 healthcare leaders, reflected an industry that has moved past curiosity and into a more demanding phase of transformation. Artificial intelligence (AI), interoperability, and digital infrastructure remained central topics … HIMSS26: From data foundations to operational execution in healthcare AI
Executive Report: Beyond transformation talk: What value-based care organizations need from analytics
Across organizations of all types and sizes, value-based care leaders describe a common tension. Most say their current technology investments align with clinical and business goals, yet budget constraints, data integration hurdles, and persistent interoperability gaps constrain execution. The Milliman MedInsight executive report explores how value-based care organizations use analytics to address rising financial pressure, … Executive Report: Beyond transformation talk: What value-based care organizations need from analytics
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Build the right data stack: How to integrate clinical and claims data for actionable intelligence
Best practices for processing clinical and claims data to support modern analytical and reporting needs Healthcare organizations are increasingly challenged to extract value from vast and varied data sources, especially as clinical and claims data become central to decision-making, regulatory compliance, and value-based care initiatives. Yet, the complexities of processing, integrating, and standardizing these data … Build the right data stack: How to integrate clinical and claims data for actionable intelligence
Measuring the unseen: Differentiation in health system services
Some health systems offer comprehensive services, while others are narrower in scope. Understanding service differentiation gives organizations important strategic insight. In this whitepaper, our goal is to illustrate one approach organizations may leverage in thinking about and quantifying a health system’s differentiation in its various markets.
Introducing our new eBook: The intersection of clinical data integration and value-based care: Strategies for success
As healthcare pivots towards value-based care (VBC), providers face intricate challenges centered on enhancing patient outcomes while managing costs effectively. This shift demands not only a change in approach but also a sophisticated integration of healthcare data to drive meaningful improvements. At the heart of VBC lies the seamless integration of Electronic Health Record (EHR) … Introducing our new eBook: <em>The intersection of clinical data integration and value-based care: Strategies for success</em>
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
Sustaining payer success: Key themes from Becker’s Payer Issues Roundtable
In an era shaped by unpredictable shifts in the healthcare landscape, innovative approaches took center stage at Becker’s Payer Issues Roundtable Spring 2025. For those sessions highlighting data insights through advanced analytics, the necessity of quality data is undeniable. Multiple speakers pointed out that maintaining a competitive advantage depends on proactive planning supported by sophisticated … Sustaining payer success: Key themes from Becker’s Payer Issues Roundtable
New eBook: Harnessing analytics and AI: A modern guide to risk adjustment
Reliable risk adjustment processes are a critical factor in the success of value-based care, but harnessing the array of data needed to align healthcare costs and provider compensation can be a challenging undertaking. With a growing number of patients enrolled in VBC programs, including the more than 33 million patients enrolled in Medicare Advantage (MA), … New eBook: Harnessing analytics and AI: A modern guide to risk adjustment
