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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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Milliman MedInsight named 2022 best in KLAS for payer quality analytics with the introduction of cloud-based digital integration
Seattle, WA – February 17, 2022 – MedInsight, Milliman, Inc.’s highly regarded platform for data warehousing and healthcare analytics, was named the number one provider solution for Payer Quality Analytics in the 2022 Best in KLAS: Software and Services report. KLAS, a research firm focused on the healthcare IT market since 1996, publishes the Best in KLAS … Milliman MedInsight named 2022 best in KLAS for payer quality analytics with the introduction of cloud-based digital integration
Reporting Framework for Value Based Care
As the cost of healthcare continues to rise, both payers and providers continue the “triple aim” of delivering effective quality care while managing their costs. Value based care (VBC), or value based reimbursements, has emerged as an effective mechanism for achieving this goal. In fact, based on estimates developed by National Business Group on Health, … Reporting Framework for Value Based Care
Chronic Condition Analysis: Selecting a Diagnostic Grouper
With over 77,000 codes, ICD10 diagnosis codes provide a much needed level of granularity for clinicians to use in caring for patients, but they are not particularly useful for large scale analytics. As a result, analysts have developed many different diagnostic groupers to group ICD10 codes into meaningful categories for analysis. Several are available within … Chronic Condition Analysis: Selecting a Diagnostic Grouper
Data Confidence for ACOs
Incomplete Provider Data Provider level analysis is extremely important for ACOs. ACOs need to know which providers both within and outside the ACO network are providing services to patients attributed to the ACO. This is important not only to work towards bringing a larger percentage of services in-network (leakage management), but also for quality and … Data Confidence for ACOs
Milliman MedInsight ranked best in KLAS for payer quality analytics for third year in a row
Seattle, WA – February 18, 2021 – MedInsight, Milliman, Inc.’s highly regarded platform for data warehousing and healthcare analytics, ranked number one in the 2021 Best in KLAS: Software and Services report for Payer Quality Analytics. MedInsight receives this honor for the third year in a row. KLAS, a research firm focused on the healthcare … Milliman MedInsight ranked best in KLAS for payer quality analytics for third year in a row
MedInsight achieves HITRUST CSF® Certification to mitigate risk and enhance security posture
Seattle, WA – February 3, 2021 – MedInsight executives announced today the MedInsight Solution has achieved Certified status for information security by HITRUST. HITRUST CSF Certification recognizes that MedInsight, the industry leading healthcare analytics ecosystem from Milliman, adheres to the highest standards for healthcare data security and privacy. “Over 300 healthcare organizations trust MedInsight with … MedInsight achieves HITRUST CSF® Certification to mitigate risk and enhance security posture
