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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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Pre-operative Laboratory Testing for Low Risk Surgeries
Practical Analytic Approaches to Healthcare Challenges Routinely performing pre-operative testing is a common practice prior to surgery. The American Society of Anesthesiologists (ASA) Task Force defines routine tests as those done in the absence of any specific clinical indication or purpose (i.e. tests intended to discover a disease or disorder in an asymptomatic patient).1 Routine … Pre-operative Laboratory Testing for Low Risk Surgeries
Is Risk Adjustment Enough in Population Analytics?
Practical Analytic Approaches to Healthcare Challenges Most analysts conducting population health data analysis understand that no two populations are completely the same. Even within a population with similar attributes – people with congestive heart failure, for example – there will be variances in the population subgroups. Many factors contribute to these variances, including age and … Is Risk Adjustment Enough in Population Analytics?
Task Force on Low Value Care: Fall Convening
Practical Analytic Approaches to Healthcare Challenges The excitement in the room was palpable as 28 attendees descended on the Westin’s Earhart Room in Detroit, Michigan. Stakeholders from across the nation gathered on September 13 with a common goal—to reduce wasteful healthcare services in the United States. Our charge for the day was to prioritize 29 … Task Force on Low Value Care: Fall Convening
What a Pain: Wasteful Low Back Pain Treatments Are Identified
Practical Analytic Approaches to Healthcare Challenges Low back pain is a common problem: more than one in four adults surveyed report having had low back pain during the past three months. Though most low back pain resolves on its own, without medical intervention, it remains one of the most common reasons for physician visits. Imaging … What a Pain: Wasteful Low Back Pain Treatments Are Identified
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
