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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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Mitigating the impact of high-cost claimants with Employer Group Insights
It is widely recognized that a relatively small segment of a population can drive a significant percentage of overall healthcare expenditures. While some health plan members with minimal healthcare needs may not utilize any healthcare services, there are others who are high utilizers of the health system. Referred to as high-cost claimants, these individuals can … Mitigating the impact of high-cost claimants with Employer Group Insights
An ocean of data & a desert of insight: transforming healthcare payer data into strategic insights
From claims to EMRs to lab and third-party data, healthcare payers have more data than ever at their fingertips – over 2.3 zettabytes per year according to a Statista projection. And healthcare data continues to grow. The value of data-driven insights for payers is undeniable. Yet, many payers struggle with transforming mounting data into data-driven … An ocean of data & a desert of insight: transforming healthcare payer data into strategic insights
How the pandemic sparked a digital transformation in healthcare data analytics
The COVID-19 pandemic revolutionized the way healthcare organizations transform data into timely information, reporting and decision-making. When the pandemic first hit, the general approach to healthcare data analytics was lacking: critical data could not be accessed in real-time nor made available to other healthcare providers, policymakers and the public. For example, ICU bed utilization was … How the pandemic sparked a digital transformation in healthcare data analytics
Practice patterns of antibiotics prescriptions for URI
Antibiotics are prescribed at more than 100 million adult ambulatory care visits annually, and 41% of these prescriptions are for respiratory conditions. In the United States, at least 2 million antibiotic-resistant illnesses and 23,000 deaths occur each year, at a cost to the U.S. economy of at least $30 billion.1 The most common reason for … Practice patterns of antibiotics prescriptions for URI
Nonprofit health system: Improve patient outcomes by “looking outside the silo”
When one of the South’s largest not-for-profit healthcare systems recently searched for a new healthcare data analytics solution, a key goal was establishing a consistent methodology for identifying and solving problem areas. A previous attempt with another data aggregator and vendor had stalled: a messy implementation process had dragged on for years, and even worse, … Nonprofit health system: Improve patient outcomes by “looking outside the silo”
How to ensure effective & agile healthcare decision-making
Between what’s publicly available and what your organization has captured, there’s no shortage of healthcare data – but is it current? Can you trust it? Can you identify conclusions and trends within it? Most importantly, can you make meaningful decisions and take impactful actions with confidence based on your healthcare data? Making more timely, well-informed … How to ensure effective & agile healthcare decision-making
