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Under CJR-X, quality decides more than cost: Two former CMS officials on what the earlier bundles reveal
Key Highlights Introduction › Interview › What this means for your hospital › With the CJR-X final rule now released in July 2026, the first mandatory, nationwide episode-based payment model for lower extremity joint replacement is set to begin on January 1, 2028. For most acute care hospitals, participation is now settled and required, and … Under CJR-X, quality decides more than cost: Two former CMS officials on what the earlier bundles reveal
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
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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
Milliman MedInsight unveils expanded Payer Platform capabilities to drive operational excellence
Seattle, WA – June 17, 2025 – Milliman MedInsight® (MedInsight), a leading healthcare data and analytics software provider and division of Milliman, announced today the expansion of its Payer Platform with the launch of the new Payer Insights application. Powered by the Milliman MedInsight Health Cloud, Payer Insights goes beyond traditional analytics by providing health … Milliman MedInsight unveils expanded Payer Platform capabilities to drive operational excellence
Navigating value-based care in 2025: How to implement it successfully in your practice
The healthcare industry is changing rapidly, influenced by new regulations, higher consumer expectations, and increasing cost pressures. In addition, the Centers for Medicare & Medicaid Services (CMS) has a big goal: by 2030, all Medicare beneficiaries should be in value-based care (VBC) arrangements. This means we’re seeing a fast shift away from the traditional fee-for-service … Navigating value-based care in 2025: How to implement it successfully in your practice
Elevate your healthcare data stack: Insights for healthcare leaders
A guide for healthcare executives to ditch outdated “data moving truck” approaches Discover how forward-thinking healthcare organizations are transforming data and insight sharing—without relying on outdated, cumbersome “data moving truck” methods. In this webinar, MedInsight experts reveal modern strategies for secure, agile, and scalable information exchange tailored for healthcare leaders. Join us to learn how … Elevate your healthcare data stack: Insights for healthcare leaders
Executive data security briefing – 4 questions every healthcare leader should be asking in 2025
As healthcare breaches grow in scale and impact, data security has become a top boardroom priority—not just an IT concern. In this on-demand session, Milliman MedInsight experts break down what every healthcare executive should be asking when it comes to protecting sensitive data and choosing trusted partners. This webinar is designed for c-suite executives and … Executive data security briefing – 4 questions every healthcare leader should be asking in 2025
Data-driven strategies for effective pharmacy management — with a spotlight on GLP-1s
Pharmacy costs continue to climb each year, influenced by the introduction of innovative therapies, growing consumer demand, and changing federal regulations. For plan sponsors, the increased use of glucagon-like peptide-1 (GLP-1) medications presents ongoing financial challenges, especially as manufacturers pursue expanded indications for these drugs beyond diabetes and weight management. Join Milliman MedInsight experts as … Data-driven strategies for effective pharmacy management — with a spotlight on GLP-1s
