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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
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
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Methodology for Identifying Inpatient Admission Events
Practical Analytic Approaches to Healthcare Challenges Evidence-based measures (EBMs) and many other health insurance data analytics require counts of inpatient admission events and associated costs. There are multiple ways to identify and count inpatient admission events, each of which may produce a different result. As per the California Department of Health Services, the methodologies used … Methodology for Identifying Inpatient Admission Events
MedInsight Chosen to Identify Unnecessary Costs and Procedures in Healthcare Delivery
Practical Analytic Approaches to Healthcare Challenges Milliman announced today that its healthcare tool, the MedInsight® Health Waste Calculator, has been chosen by two state All Payer Claims Databases (APCDs) and a leading Regional Health Improvement Collaborative to aid in their identification of unnecessary costs and procedures in healthcare delivery. The Virginia Center for Health Innovation … MedInsight Chosen to Identify Unnecessary Costs and Procedures in Healthcare Delivery
Covered California: Leveraging Telemedicine for Network and Quality Management
Healthcare purchasers, including state-based marketplaces, are making a push to move healthcare payments from volume to value and to transform the delivery system to promote quality of care. Covered California is seeking to do this through its contracting health plans and the qualified health plan (QHP) solicitation process. The most recent solicitation lays out key … Covered California: Leveraging Telemedicine for Network and Quality Management
Potential Overuse of Coronary Angiography Amongst Asymptomatic Population
Coronary angiography is a key diagnostic tool in the management of patients with coronary artery disease. Coronary angiography is used to identify narrowing in coronary arteries and is used for decision support to ascertain the need for revascularization to minimize the risk of myocardial infarction. Various research studies have evaluated trends in the use and … Potential Overuse of Coronary Angiography Amongst Asymptomatic Population
Supporting Patient-Centered Medical Homes through Healthcare Analytics
Although the concept of Patient-Centered Medical Homes (PCMH) has been around for more than 50 years 1, the last decade has seen a revitalization of the PCMH model and an increase in its presence across the nation. The model’s popularity hinges on an approach to providing comprehensive primary care and redesigning healthcare delivery processes. This is … Supporting Patient-Centered Medical Homes through Healthcare Analytics
Top Five Analytic Trends
It goes without question that the U.S. health insurance industry is in a state of flux. Americans are buying individual products through health insurance marketplaces, new insurance carriers have entered the market, and Medicaid has been expanded in 29 states and the District of Columbia. These market changes, in addition to other reform provisions already … Top Five Analytic Trends
