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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
Measuring how GLP-1 medications impact the total cost of care
Flexible analytics are valuable tools to inform the management of costs and outcomes for therapies such as glucagon-like peptide-1 (GLP-1) drugs, having a significant impact on payer spending and trend. This paper summarizes central themes and provides illustrative examples from Milliman’s GLP-1 Impact Dashboard suite of analytics to facilitate the strategic management of GLP-1-related care. … Measuring how GLP-1 medications impact the total cost of care
Expanding value-based care: The essential role of specialists in long-term success and patient outcomes
Value-based care (VBC) is reshaping the healthcare landscape by focusing on improving patient outcomes while keeping costs under control. Unlike fee-for-service (FFS) reimbursement, this approach prioritizes quality rather than quantity, aiming to reward effective treatments and preventative strategies that can lead to healthier communities and more sustainable healthcare spending. Traditionally, VBC initiatives have zeroed in … Expanding value-based care: The essential role of specialists in long-term success and patient outcomes
Navigating population health with clarity: Dr. Kodama’s expert tips for success in value-based healthcare
The shift toward value-based care (VBC) is transforming how services are delivered, focusing on improving patient outcomes and engagement while reducing costs. Success in this model depends on understanding your population, managing their health proactively, and coordinating care effectively. Meet Dr. Christopher Kodama, Chief Medical Officer at Milliman MedInsight. With a clinical background in pediatric … Navigating population health with clarity: Dr. Kodama’s expert tips for success in value-based healthcare
CMS 2025 RADV audit expansion: Key changes and what they mean to MA plans
In a significant move announced on May 21, 2025, the Centers for Medicare & Medicaid Services (CMS) revealed plans to initiate annual Risk Adjustment Data Validation (RADV) audits for all Medicare Advantage (MA) plans. In this memo, CMS Administrator, Dr. Mehmet Oz, is quoted as saying “We are committed to crushing fraud, waste and abuse … CMS 2025 RADV audit expansion: Key changes and what they mean to MA plans
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The best of 2024: Exploring digital transformation, Gen AI and VBC
In the rapidly transforming landscape of healthcare analytics, it is difficult to predict what a new year will bring. However, looking back, it is clear that developments around digital transformation, generative AI (Gen AI) and value-based-care (VBC) have continued to stay top of mind for both payer and provider organizations. The past year has seen … The best of 2024: Exploring digital transformation, Gen AI and VBC
Streamlining provider profiling with focused reference data
In healthcare markets across the country, reliable and descriptive data is critical for stakeholders to make informed, strategic decisions. A robust source of claims and encounter data are perhaps the most flexible and comprehensive sources of market information one might use, and adaptable to almost any strategic need. However, such large resources are not accessible … Streamlining provider profiling with focused reference data
Performance benchmarking with the power of Milliman MedInsight research, reliability, and expertise
To improve your performance in a competitive healthcare marketplace, you have to know exactly where you stand. You need tools that let you drill deep into the factors driving costs, utilization and trends. Milliman MedInsight benchmarking tools, built on a database of 95 million members, 4 billion claim lines annually, and more than 75 years … Performance benchmarking with the power of Milliman MedInsight research, reliability, and expertise
Integrated risk adjustment solutions: Enhancing reimbursement and patient care
Accurate risk adjustment is essential for fair reimbursement and optimal patient care in value-based care. However, issues like inaccurate risk scoring, poor HCC documentation and coding, and undocumented or untreated conditions can create a large burden for both payers and providers, leading to expensive and time-consuming processes. In this webinar, Milliman MedInsight will explore innovative … Integrated risk adjustment solutions: Enhancing reimbursement and patient care
2024 Insights: Key trends reshaping healthcare analytics
As we prepare for the new year, the healthcare industry has been propelled forward by remarkable advancements in Generative AI (Gen AI), value-based care (VBC), and the electronic health record (EHR) data integration. While the overall goal of improving patient care has remained on track over the years, the introduction of Gen AI is revolutionizing … 2024 Insights: Key trends reshaping healthcare analytics
MSSP ACOs using Milliman MedInsight achieved over $549.3M of earned savings in 2023 under CMS Medicare Shared Savings Program
SEATTLE – DEC. 10, 2024 – Milliman MedInsight, a leading provider of healthcare data and analytics, is pleased to share the remarkable success of its Accountable Care Organization (ACO) clients for the 2023 Medicare Shared Savings Program (MSSP). Key highlights of 2023 performance results for Milliman MedInsight clients: Milliman MedInsight clients lead the way: Milliman MedInsight … MSSP ACOs using Milliman MedInsight achieved over $549.3M of earned savings in 2023 under CMS Medicare Shared Savings Program
