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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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Over Half of Emergency CT Scans of the Head for Dizziness Are Considered Wasteful
Practical Analytic Approaches to Healthcare Challenges Dizziness accounts for 3.3% of all Emergency Department (ED) visits annually. This corresponds to about 2.6 million ED visits per year in the United States.¹ A Computed Tomography (CT) scan of the head is one of the most frequently used diagnostic procedures for evaluation of dizziness in the ED, … Over Half of Emergency CT Scans of the Head for Dizziness Are Considered Wasteful
Top 7 Critical Point Podcasts by Milliman
Practical Analytic Approaches to Healthcare Challenges Critical Point is a podcast by Milliman, hosted by subject matter experts including actuaries, clinicians, technology specialists, and economists. These seven episodes take a deep dive into subjects that affect the health and well-being of people around the world. Critical Point examines the inherent challenges and innovative solutions that … Top 7 Critical Point Podcasts by Milliman
Diagnosis Related Group-Based Readmission Profiling
Practical Analytic Approaches to Healthcare Challenges Introduction High rates of unplanned readmissions indicate poor quality of care or gaps in care coordination, and bring an increased financial burden on the healthcare system.[i] The major reasons for unplanned readmissions include premature discharge from initial hospitalization, gaps in post-operative care, unnecessary inpatient admissions from the Emergency Department, … Diagnosis Related Group-Based Readmission Profiling
2019 Milliman Medical Index
Key findings of the 2019 MMI include: Healthcare costs are increasing at a slower rate, by historical standards. Back in the early 2000s, healthcare expenses for the MMI family of four were growing by 10% a year. Now, nearly 20 years later, growth rates are at record-low levels. We estimate that costs grew by only … 2019 Milliman Medical Index
Milliman MedInsight launches new machine-learning product: MedInsight Conditions to Consider
Seattle – July 24, 2019 – MedInsight, Milliman, Inc.’s highly regarded platform for data warehousing and healthcare analytics, has launched a new machine–learning product, MedInsight Conditions to Consider™, which uses collaborative filtering to highlight patterns in diagnoses. Many online retailers use collaborative filtering to help customers identify products that might be of interest to them. … Milliman MedInsight launches new machine-learning product: MedInsight Conditions to Consider
Drug Cost Trends 2015 to 2017 & The Top 20 Drugs
Practical Analytic Approaches to Healthcare Challenges The Centers for Medicare and Medicaid Services (CMS) identifies prescription drugs as one of the major components of U.S. national health expenditures, after hospital care and physician services.1 The US Assistant Secretary for Planning and Evaluation (ASPE ; principal advisor to the Secretary of the U.S. Department of Health … Drug Cost Trends 2015 to 2017 & The Top 20 Drugs
