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From readiness to reality: What TEAM’s first year is really testing
In January 2026, CMS’s Transforming Episode Accountability Model (TEAM) moved from policy to practice. For hospitals in mandatory regions, TEAM is no longer something to prepare for on paper; it is live, operational, and beginning to influence how episode performance is evaluated clinically, financially, and operationally. Many organizations are entering 2026 with a measured posture. … From readiness to reality: What TEAM’s first year is really testing
Medicare Advantage 2026: Breaking down the new risk model and its impact in plain terms
The Centers for Medicare & Medicaid Services (CMS) introduced CMS-HCC Version 28 (V28) in 2024 as the next evolution of Medicare Advantage (MA) risk adjustment. For many organizations, the “new CMS-HCC model” felt more theoretical than operational, something plans were preparing for but not fully experiencing. That changes in 2026, when V28 becomes operational at … Medicare Advantage 2026: Breaking down the new risk model and its impact in plain terms
How CareFirst BlueCross BlueShield modernized analytics to cut cost of care
Health plans are walking a tightrope. On one side, utilization is climbing and breakthrough therapies, while clinically promising, are reshaping cost curves. On the other hand, members, employers, and providers expect more convenience, transparency, and value. The mandate is clear: deliver better outcomes and experiences without sacrificing affordability. Meeting that mandate requires more than more … How CareFirst BlueCross BlueShield modernized analytics to cut cost of care
Physician performance enablement: Engaging providers with actionable insights for ACO success
Many organizations now have access to more data than ever before, yet they often struggle to transform this information into practical actions that lead to real improvements in population health. Physicians play a vital role in this process and should be involved early when turning data into meaningful insights that are practical, effective, and aligned … Physician performance enablement: Engaging providers with actionable insights for ACO success
HIMSS26: From data foundations to operational execution in healthcare AI
The HIMSS Global Health Conference and Exhibition has long served as a signal for where healthcare technology is headed. This year’s conference, attended by more than 24,000 healthcare leaders, reflected an industry that has moved past curiosity and into a more demanding phase of transformation. Artificial intelligence (AI), interoperability, and digital infrastructure remained central topics … HIMSS26: From data foundations to operational execution in healthcare AI
Executive Report: Beyond transformation talk: What value-based care organizations need from analytics
Across organizations of all types and sizes, value-based care leaders describe a common tension. Most say their current technology investments align with clinical and business goals, yet budget constraints, data integration hurdles, and persistent interoperability gaps constrain execution. The Milliman MedInsight executive report explores how value-based care organizations use analytics to address rising financial pressure, … Executive Report: Beyond transformation talk: What value-based care organizations need from analytics
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Optimizing the Total Cost of Care with payer analytics
Health plans now operate in a far more complex environment than in past years. With economic uncertainty, shifting market forces, and regulatory changes, there is increasing pressure for health plans to do more than just maintain performance; they must deliver real, measurable value. To succeed in managing the Total Cost of Care (TCOC), health plans … Optimizing the Total Cost of Care with payer analytics
Bridging the gaps: Ensuring provider network adequacy with the Milliman Network Optimizer
Building a provider network that meets adequacy standards is no small feat for healthcare organizations. As regulatory requirements evolve and patient needs diversify, ensuring beneficiaries have timely access to the right providers becomes increasingly complex. Organizations must navigate a maze of compliance benchmarks, analyze vast and often fragmented data, and address gaps across multiple specialties … Bridging the gaps: Ensuring provider network adequacy with the Milliman Network Optimizer
Milliman MedInsight launches Network Optimizer to enhance provider management
Seattle, WA – January 29, 2026 – Milliman MedInsight® (MedInsight), a leading healthcare data and analytics software provider and division of Milliman, announced today the introduction of the Milliman Network Optimizer application. Powered by Milliman’s industry expertise and the MedInsight Provider Registry, the Network Optimizer delivers actionable insights beyond traditional adequacy measures. It evaluates provider … Milliman MedInsight launches Network Optimizer to enhance provider management
Provider network optimization – Finding value in the details
Timely access to healthcare services is an important enabler of positive health outcomes. Access to care remains a significant challenge in the United States where, historically, approximately 16% of adults Americans have reported long wait times and difficulty getting appointments for routine care as soon as needed. Demand for healthcare services has grown over the … Provider network optimization – Finding value in the details
Network Optimizer
The Milliman Network Optimizer empowers healthcare organizations and regulators to build and manage high-performing networks with confidence.
Breaking the cycle: Analyzing avoidable ER trips and what can be done about them
This study examines patterns and drivers of Emergency Department utilization in the United States by applying the NYU Emergency Department Algorithm to a large, multi-year claims dataset to identify potentially avoidable visits and populations that could benefit from targeted care management interventions.
