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Build or buy? A guide to modernizing healthcare analytics for payers and providers
For modern healthcare organizations, reliable, scalable, and state-of-the-art data analytics capabilities are not optional. They are a foundational business requirement for an industry expected to deliver continual improvements in both quality of care and the cost of providing it. Keeping up with evolving technology and innovation in healthcare can be a challenging exercise, beginning with … Build or buy? A guide to modernizing healthcare analytics for payers and providers
2024 MSSP success: How Milliman MedInsight VBC solutions help ACOs outperform national averages
Every summer, the Centers for Medicare & Medicaid Services (CMS) announces settlement results for the Medicare Shared Savings Program (MSSP), an update that Accountable Care Organization (ACO) leaders, analysts, and policy experts eagerly anticipate. The MSSP results are more than just numbers in a report; they reflect how well ACOs are delivering value-based care (VBC) … 2024 MSSP success: How Milliman MedInsight VBC solutions help ACOs outperform national averages
Success in value-based care with Milliman MedInsight VBC Platform + ACO Builder
In value-based care (VBC), the strength and effectiveness of the provider network play a major role in determining success under a risk-bearing contract. The right mix of providers can improve outcomes, reduce costs, and help achieve savings targets. The wrong mix can lead to missed quality measures, financial losses, and patient dissatisfaction. Historically, however, network … Success in value-based care with Milliman MedInsight VBC Platform + ACO Builder
Transforming value-based care performance with the MedInsight VBC Platform
Value-based care (VBC) shifts the focus from the quantity of healthcare services delivered to the quality and effectiveness of care provided. In this model, providers are rewarded for improving patient outcomes, enhancing care efficiency, and refining resource use. This shift matters because it aligns incentives with what truly benefits patients: better health, the right amount … Transforming value-based care performance with the MedInsight VBC Platform
Precision is key: How payers can unlock strategic insights from claims and clinical data integration
Today, payers face mounting pressure to deliver better outcomes, control the cost of care, and manage financial risk. Meeting these goals requires more than access to raw data—it demands actionable insights that support strategic, cost-effective decision-making. This is where the integration of clinical and claims data becomes transformative. By bridging the gap between clinical records … Precision is key: How payers can unlock strategic insights from claims and clinical data integration
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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
THMA Fall 2025 CFO Forum
Milliman MedInsight to join The Health Management Academy Fall 2025 CFO Forum Milliman MedInsight is excited to join The Health Management Academy Fall CFO Forum—an exclusive convening of Chief Financial Officers from the nation’s top health systems and pioneering healthcare organizations. This premier event provides a unique platform for meaningful connections and open dialogue on … THMA Fall 2025 CFO Forum
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
Elevate your organization’s AI usage: Gen AI in Healthcare webinar
AI is progressing rapidly, and implementing new technologies is becoming increasingly necessary for organizations looking to increase operational efficiency. At MedInsight, we utilize AI to enhance products and services, protect PHI, and deliver faster, better insights for our clients. However, implementing AI is not a straightforward process, and questions often arise such as how can … Elevate your organization’s AI usage: Gen AI in Healthcare webinar
