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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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MSSP ACOs using Milliman MedInsight achieved over $274M shared savings in 2022 under CMS Medicare Shared Savings Program
SEATTLE, WASH. – Nov. 17, 2023 – Milliman MedInsight, a leading healthcare data and analytics company, is pleased to announce the outstanding achievements of Accountable Care Organizations (ACOs) utilizing the Milliman MedInsight healthcare analytics platform in support of the Medicare Shared Savings Program (MSSP) for the 2022 performance year. Key Highlights of 2022 Performance Results … MSSP ACOs using Milliman MedInsight achieved over $274M shared savings in 2022 under CMS Medicare Shared Savings Program
Overcoming key data challenges to drive the future of value-based care
Value-based care (VBC) models are rapidly gaining prominence in the healthcare industry, revolutionizing the way healthcare is delivered. To ensure that provider organizations make the transition, the Centers for Medicare & Medicaid Services (CMS) has implemented several initiatives that offer incentives in favor of performance-based payments. These include alternative payment models such as Medicare Shared … Overcoming key data challenges to drive the future of value-based care
MedInsight unveils enhanced Value-Based Care Platform
Seattle, WA – Oct. 24, 2023 – Milliman MedInsight, a leading healthcare data and analytics company, proudly announces the launch of its upgraded Value-Based Care (VBC) Platform®. This advanced platform harnesses Milliman MedInsight’s renowned analytics expertise and introduces expanded features tailored to accountable care organizations (ACOs). Empowering ACOs on the Journey to Value-Based Care The … MedInsight unveils enhanced Value-Based Care Platform
Bundles
The MedInsight Bundles application offers organizations participating in bundled payment programs the insights they need to efficiently manage the payment models implemented by the Center for Medicare and Medicaid Innovation (CMMI).
