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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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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
Data-driven payer strategies: Survey insights and solutions
Health plans are investing heavily in analytics and AI, but many still struggle to turn insight into meaningful action. Join MedInsight for a data-driven discussion of findings from our Payer Market Survey, and what they reveal about the widening gap between analytics ambition and operational impact. As margin pressures mount, organizations are prioritizing cost and utilization analytics like never before, yet effectiveness in managing … Data-driven payer strategies: Survey insights and solutions
From noise to signal: How ACOs use analytics to gain confidence in a changing CMMI landscape
Increasing uncertainty – driven by changing CMS/CMMI models, MA HCC updates, and Medicaid funding pressures – demands data-driven clarity. Milliman will show how ACOs leverage analytics to build confidence, with practical discussions on fraud monitoring, risk score analytics, and readiness for models like LEAD, TEAM, ASM, and ACCESS.
Learn how payers are using analytics and AI to drive impact: Insights and trends
Health plans of all sizes recognize that strong analytics capabilities are essential to future success. In particular, analytics support reliable evaluation of cost and utilization patterns, quality and outcome measures, and risk adjustment. However, major challenges remain, integrating new technology with legacy systems and addressing limited and analytic resources. The Milliman MedInsight Executive Report explores … Learn how payers are using analytics and AI to drive impact: Insights and trends
New report offers a glimpse into how VBC organizations view the role of analytics in their clinical and business goals
With benchmarks tightening and growing pressure to maximize cost and utilization efficiency under the value-based care model, healthcare provider organizations of all sizes are turning to analytics for answers. As part of our 2025 Provider Market Survey, Milliman MedInsight sought input from provider organizations on their analytics priorities and challenges as well as their vision … New report offers a glimpse into how VBC organizations view the role of analytics in their clinical and business goals
CMS’s new ACO LEAD model
The Centers for Medicare & Medicaid Services’ (CMS) Long-term Enhanced Accountable Care Organization (ACO) Design (LEAD) model presents a significant opportunity to improve care coordination, financial alignment, and outcomes for individuals dually eligible for Medicare and Medicaid. This paper summarizes key themes and strategic considerations from Milliman’s analysis of the LEAD model, highlighting potential implications … CMS’s new ACO LEAD model
