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Harnessing analytics and AI: A modern guide to risk adjustment
Value-based care (VBC) models are reshaping the delivery, measurement, and funding of healthcare at an accelerated pace, making precise risk-adjustment processes essential for ensuring that reimbursements and premiums accurately reflect actual care costs. Accurate risk adjustment creates a fair and sustainable link between healthcare costs and provider compensation in risk-sharing arrangements. To succeed requires careful … Harnessing analytics and AI: A modern guide to risk adjustment
Top 3 takeaways from NAACOS Spring 2025 Conference
The NAACOS Spring Conference 2025, held April 22-24 in Baltimore, brought together a dynamic mix of healthcare professionals, policymakers, and innovators, dedicated to shaping the future of Accountable Care Organizations (ACOs). This year’s event underscored the need for health systems to address evolving challenges and advance value-based care (VBC) to enhance care quality, improve patient … Top 3 takeaways from NAACOS Spring 2025 Conference
Becker’s Payer Issues Roundtable 2025: Charting Medicare Advantage growth
In April, the Becker’s Payer Issues Roundtable 2025 gathered industry leaders to examine the key challenges facing payers, including the impact of changing regulations and the future of Medicare Advantage (MA). Marcos Dachary, Principal and Chief Market Strategist and General Manager of Payer Solutions at Milliman MedInsight, participated in a panel discussion to explore topics … Becker’s Payer Issues Roundtable 2025: Charting Medicare Advantage growth
Payer analytics in focus: Emerging trends
Last year, our payer articles focused on accelerating digital transformation, increasing transparency and trust in value-based care, and strengthening data foundations. As we move into 2025, we draw on a recent Milliman MedInsight survey of payer customers to offer key insights for payer executives and analytics teams. This article explores the hurdles payers face—from data … Payer analytics in focus: Emerging trends
Next-level risk adjustment: Empowering patient outcomes and financial efficiency
Risk adjustment relies on a long list of health and demographic data points to estimate the cost of patient care across a specific population. Getting it right is critical for ensuring that reimbursements accurately reflect the cost of value-based care. As the data picture becomes more complete, the promise of risk adjustment processes to deliver … Next-level risk adjustment: Empowering patient outcomes and financial efficiency
Building transparency: Best practices for optimizing value-based performance reporting
Transparency plays a crucial role in value-based performance (VBP) reporting. It ensures accountability and trust between health plans and healthcare providers. In a system where outcomes matter, clear reporting fosters better decision-making and collaboration, increasing stakeholders’ commitment to quality care. In this blog post, Milliman MedInsight Marketing Director Sarah Quinn explains the role of technology … Building transparency: Best practices for optimizing value-based performance reporting
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2024 Outlook: Five key analytic capabilities shaping VBC
The healthcare industry is undergoing a transformation, largely driven by value-based care (VBC), artificial intelligence (AI), and digital transformation. These trends, which gained significant momentum in 2023, will continue to shape the healthcare industry in 2024 and beyond. As organizations aim to improve efficiencies and the delivery of care, the increasing use of analytics emerges … 2024 Outlook: Five key analytic capabilities shaping VBC
Leading the way in value-based care: Best practices for mitigating risk
The healthcare landscape is rapidly evolving to one in which value and accountable care are the predominant measures for delivering high-quality, affordable care. It is an evolution that has been underway for more than a decade, but recent years – and the demands of an aging population – have brought transformation at a rapidly growing … Leading the way in value-based care: Best practices for mitigating risk
Advanced Health: Holistic population health improvement integrating claims and clinical data
Oregon-based Advanced Health is a coordinated care organization (CCO) – the state’s version of an accountable care organization (ACO) – that takes an innovative approach to the care of its 26,000 members. Serving two counties where 14-17% of residents live in poverty, according to U.S. Census data, Advanced Health manages a population with complex medical … Advanced Health: Holistic population health improvement integrating claims and clinical data
A survey of provider information in medical claims data
Clean data is critical for analytical work of all kinds, and healthcare claims data is no exception. In this whitepaper published by Milliman MedInsight, Senior Data Scientist Brian Merkey PhD, discusses the relevance of clean data for one narrow element in the healthcare data ecosystem: provider information in medical claims datasets. This work shares the … A survey of provider information in medical claims data
A year in review: The growing role of analytics in value-based care
This past year, the industry has witnessed significant advancements in value-based care (VBC) models. As the industry continues to move away from traditional fee-for-service models, there has been a growing emphasis on population health management, the integration of technology and analytics, and the implementation of collaborative care models. These developments have been instrumental in driving … A year in review: The growing role of analytics in value-based care
Addressing pharmacy drug trends with employer group reporting
According to a new study by the Business Group on Health, over 90% of employers reported concern over high-cost drugs and increasing pharmacy costs. This figure is not surprising when you consider that the average list price increase was nearly $150 per drug in January 2022 and rose to $250 by July 2022. During the … Addressing pharmacy drug trends with employer group reporting
