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AI in healthcare analytics: Milliman MedInsight’s approach to delivering trusted answers at speed and scale
Organizations are under growing pressure to make faster, more confident decisions in an increasingly complex healthcare environment. As healthcare continues shifting to value-based care, administrative tasks and data volumes are both growing. Although many leaders see artificial intelligence (AI) as a possible solution, it also brings new challenges. Without access to accurate data, a strong … AI in healthcare analytics: Milliman MedInsight’s approach to delivering trusted answers at speed and scale
Value-based care requires value-based operations: A framework for operational alignment
In healthcare, value-based care (VBC) is more than a familiar phrase. It represents a commitment to better patient outcomes and more thoughtful use of resources. Yet as the industry shifts from fee-for-service (FFS) reimbursement to value-based contracts, a significant gap persists. We often focus on contract design, aligned incentives, shared savings, and risk-bearing arrangements. But … Value-based care requires value-based operations: A framework for operational alignment
Beyond the diagnosis: The financial toll of cancer amid chronic conditions
Cancer is a leading cause of death worldwide, accounting for nearly 10 million deaths in 2020, or nearly one in six deaths. In the United States, the percentage of adults who have ever been diagnosed with cancer is 10.3% in 2024 and cancer is the number two cause of death across all chronic conditions. Cancer … Beyond the diagnosis: The financial toll of cancer amid chronic conditions
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
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Pandemic induced medical loss ratio opportunities
Medical expenditures in the US were down steeply in 2020 due to deferred and forgone care associated with the COVID-19 pandemic, leading to historically low medical loss ratios (MLR) for insurers. For insurers, who must comply with state and federal minimum MLR regulations or pay costly rebates and remittances, this state of affairs brings with … Pandemic induced medical loss ratio opportunities
Medical action planning at Ochsner Health Network
Join us to learn how Ochsner Health uses Cost and Utilization analysis to measure performance and identify opportunities to lower the cost of care. Ochsner will share how they have leveraged MedInsight to understand cost drivers and engage their providers and healthcare systems in actionable ways, by bringing together all payer data to standardize reporting … Medical action planning at Ochsner Health Network
Learn how Covenant Health and Scripps ACO use claims-based analytics to manage risk contracts
If you are just beginning to or are already managing multiple risk contracts, high quality data aggregation is essential. Using claims data is key to assessing your ACO’s financial performance against the benchmark target, identifying opportunities for improvement, and achieving your shared savings goals. Another key to success is measuring the performance of the ACO … Learn how Covenant Health and Scripps ACO use claims-based analytics to manage risk contracts
Knowing your population – risk scores and risk stratification
In a world of value-based care, the ability to stratify patients by risk is vital to achieving improved health outcomes, lower costs, and better patient experience. In this webinar, we will discuss insights and features of key risk scoring methods. Additionally, with permission from some of our clients, we will share example stories about their … Knowing your population – risk scores and risk stratification
Improving clinical documentation for risk adjustment
In this webinar you will learn how to improve clinical documentation for risk adjustment using MedInsight’s Conditions to Consider. The product identifies and leverages similarities between patients within a population to ensure appropriate patient morbidity in risk-based contracts, and assists in medical case finding initiatives. Using machine learning analytics, Conditions to Consider identifies potential gaps … Improving clinical documentation for risk adjustment
Hospital contracting modernization at Blue Cross Blue Shield of Kansas City
Learn how Blue Cross and Blue Shield of Kansas City are using MedInsight GlobalRVUs and Medicare Lite to benchmark hospital value, improve the contract structure, simplify negotiations, and reduce administrative costs for both payers and providers. Speakers Randy Oursler DVP, Chief Actuary, Blue Cross and Blue Shield of Kansas City Managing Director, Torch Insight Charlie … Hospital contracting modernization at Blue Cross Blue Shield of Kansas City
