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Becker’s Payer Issues Roundtable Recap: Key insights for health plan leaders
At this year’s Becker’s Payer Issues Roundtable, one message came through consistently: the challenge for payer organizations isn’t new ideas. They need execution that measurably bends trend while keeping decisions defensible in a more scrutinized environment. Across markets, leaders described a world of tighter margins, higher acuity, member disruption, and growing expectations that plans will … Becker’s Payer Issues Roundtable Recap: Key insights for health plan leaders
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
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COVID-19 impact on healthcare utilization, enrollment, and cost: Insights from emerging experience and modeling
In this webinar, we discuss initial insights from emerging claims experience and observe shifts in healthcare utilization and cost, including specific examples of analytic use cases. We also review Milliman MedInsight COVID-19 dashboards available for clients to analyze their own data. Additionally, we hear from actuarial experts about modeling the return of deferred care and … COVID-19 impact on healthcare utilization, enrollment, and cost: Insights from emerging experience and modeling
CMMI’s Direct Contracting model: Participation primer
Starting in CY2021, the Center for Medicare and Medicaid Innovation (CMMI) will be operating a new total cost of care model for Medicare FFS beneficiaries called Direct Contracting (DC). It is loosely modeled on CMMI’s Next Generation ACO model as well as the Center for Medicare and Medicaid Services’ (CMS’s) Medicare Shared Savings Program (MSSP). … CMMI’s Direct Contracting model: Participation primer
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Assessing the impact of COVID-19 on risk contracts
During this time of national uncertainty, health care providers are fully engrossed in maintaining daily operations and ensuring continuity of care for their patients amid the COVID-19 crisis. COVID-19 creates a myriad of uncertainties for Accountable Care Organizations (ACOs), which can seem overwhelming. Understanding the economic and clinical impact of COVID-19 requires innovative and flexible … Assessing the impact of COVID-19 on risk contracts
THMA Fall 2025 Value-Based Strategy Collaborative
Milliman MedInsight is excited to take part in The Health Management Academy’s Fall Value-Based Strategy Collaborative—an exclusive forum for senior health system executives driving the next wave of value-based care (VBC), population health, and payer-provider innovation. We’ll be engaging with leaders such as Chief Population Health Officers, SVPs of Value-Based Care Strategy, Chief Managed Care … THMA Fall 2025 Value-Based Strategy Collaborative
Advancements in quantifying low-value care opportunity: Reducing harmful cascades of care
Cascades of care refer to a succession of medical services that are often fueled by the desire to avoid even the smallest risk of a serious condition. They can follow from incidental or marginal findings on screening and diagnostic tests, some of which are themselves of low-value. Cascades of care are common and can be … Advancements in quantifying low-value care opportunity: Reducing harmful cascades of care
