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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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Do Not Overlook the Value of Claims Auditing
This article was originally published in Employee Benefit News. It was written by both David Cusick and Brian Anderson. When seeking ways to keep expenses under control, health care plan sponsors may overlook the value of claims auditing. Auditing fees may not be inconsequential, but the fact is that an accurate audit including both pharmacy … Do Not Overlook the Value of Claims Auditing
Too Many Spinal Surgeries?
Hospitals have historically relied on surgeries contributing to their top service lines and providing a significant source of revenue generation for hospitals and surgeons. This has, in part, led to the overutilization of surgeries. In the area of spinal surgeries, as noted in the Modern Healthcare article from March 24, 2014, the mounting research evidence … Too Many Spinal Surgeries?
Regional Variation in Utilization – Syncope
Area differences in healthcare utilization have been documented since an area variation analysis of tonsillectomy rates was published back in 1938. Besides the research literature, geographic variation in U.S. healthcare also has been documented extensively for the Medicare population in the Dartmouth Atlas. The Institute of Medicine also released a series of reports on geographic … Regional Variation in Utilization – Syncope
Tips for Ensuring Quality Encounter Data Submission in Medicaid Managed Care Programs
One area of data management within the healthcare industry that is getting new emphasis and interest from regulators is a focus on encounter data. Today, the majority of Americans receiving healthcare services funded through the Medicaid program are enrolled in some form of managed care. Under this scheme, states contract with MCOs that take on … Tips for Ensuring Quality Encounter Data Submission in Medicaid Managed Care Programs
Episodes of Care – Appendicitis
Evaluating the relationship between episode of care and length of stay in Appendicitis: In previous posts we have discussed some of the ways episodes of care can be used to compare two different networks and underlying practice patterns. We’d like to dive further on this thread and look at how episodes of care can be … Episodes of Care – Appendicitis
Ambulatory Care – Measuring Quality and the Impact of Nursing
The shift of medical care from the inpatient to outpatient setting coupled with the emphasis on transformative designed patient-centered medical home models provides measurement challenges and opportunities. The challenges are how to effectively measure quality in this setting given the range of services that are provided—from routine preventive care to complex surgical and invasive procedures. … Ambulatory Care – Measuring Quality and the Impact of Nursing
