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Modernizing healthcare analytics to deliver faster cost and utilization insights
Cambia Health Solutions (Cambia) serves more than 2 million members through its regional health plans and is guided by a mission to make healthcare easier and lives better. To support that mission, the organization set out to strengthen its analytics foundation with a more scalable, reliable approach to delivering timely, trusted insights for actuarial and … Modernizing healthcare analytics to deliver faster cost and utilization insights
What is risk adjustment software? A guide for healthcare organizations
Risk adjustment depends on accurate data, complete documentation, and consistent workflows. For healthcare organizations managing risk-based contracts, those requirements can become difficult to coordinate across teams, systems, and populations. Claims data may live in one place, clinical data in another, documentation review in a separate workflow, and reporting in static dashboards or spreadsheets. Risk adjustment … What is risk adjustment software? A guide for healthcare organizations
The importance of data selection in AI model training, testing, and deployment
Artificial intelligence is only as good as the data behind it. In healthcare, even small differences in inputs can lead to vastly different outcomes, making data quality and provenance critical to evaluating AI models. This whitepaper introduces the Milliman MedInsight Data Confidence Model, a structured approach built on 25 years of experience matching the right … The importance of data selection in AI model training, testing, and deployment
Signs your organization needs better clinical and claims data integration
Almost no healthcare organization intentionally builds a fragmented data environment. Fragmentation develops through reasonable decisions: an acquired practice arrives with a second EHR instance, a risk-based contract introduces another payer file, a vendor relationship brings in laboratory or pharmacy feeds. Their combined effect is a set of systems describing the same patients and members differently. … Signs your organization needs better clinical and claims data integration
How to choose the right risk adjustment vendor
Executive Summary Choosing a risk adjustment vendor should never be reduced to coding function alone. The right platform should improve documentation quality, integrate into clinical and operational workflows, provide transparent analytics, support prospective and retrospective programs, and maintain audit readiness. Organizations should prioritize configurable technology, explainable AI, strong governance, measurable outcomes, and an implementation approach … How to choose the right risk adjustment vendor
Responsible AI in healthcare analytics: The MedInsight approach
Key Highlights Introduction› Analysis in the AI era› Principles of AI adoption at MedInsight› Conclusion› Download the white paper Introduction The recent explosion of artificial intelligence (AI) capability and deployment at scale has dramatically altered conversations and expectations for technology solutions. Healthcare and healthcare analytics are no exceptions to this. AI as a technological innovation … Responsible AI in healthcare analytics: The MedInsight approach
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Milliman HealthVision360 2026
Navigating Healthcare Complexity and Creating Solutions Together Healthcare leaders are facing unprecedented pressure to improve outcomes, control costs, adapt to changing regulations, and make critical decisions with confidence. At Milliman HealthVision360, you’ll gain practical strategies, industry insights, and peer connections designed to help your organization move from complexity to clarity. Join health plan, provider, and … Milliman HealthVision360 2026
Clinical data integration: Connecting data to drive better decisions
Healthcare organizations have access to more data than ever, but fragmented clinical and claims data make it difficult to develop a complete, timely view of patient health and performance. Bringing together EHR, claims, member, lab, and other clinical data creates a more trusted foundation for analytics and helps organizations turn information into actionable insights. Join … Clinical data integration: Connecting data to drive better decisions
Will you succeed in CJR-X and TEAM? How to build a CMS-aligned view of your bundled payments
With Comprehensive Care for Joint Replacement Expanded (CJR-X) set to launch January 2028, every eligible acute care hospital in the country is facing a new reality: mandatory bundled payments across a full 90-day episode window for joint replacement procedures. This is part of a broader and accelerating shift — CMS already made bundled payments mandatory … Will you succeed in CJR-X and TEAM? How to build a CMS-aligned view of your bundled payments
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
