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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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Admissions from the ED
The New York Times recently reported on allegations that a hospital chain was unnecessarily admitting patients from the emergency department (ED) to increase revenues from Medicare and Medicaid[1]. According to the article, one hospital was accused of maintaining a scorecard to keep track of physicians who did not meet a target of admitting at least … Admissions from the ED
Medicaid Population Management
In previous blogs, we’ve discussed Population Management concepts and given specific examples of pediatrics, ACO, and clinical populations. In this blog we turn to the Medicaid population. Medicaid has unique characteristics because of the nature of the financing and because of the social demographics of the population served. This population is going through big changes … Medicaid Population Management
Eliminating Waste in the Healthcare System
Healthcare spending in the United States far exceeds that in other developed countries and the American health care system is widely recognized as wasteful. The Congressional Budget Office has concluded that up to 30 percent of the healthcare in the U.S. is unnecessary. Such estimates of waste are generally based on aggregate data such as … Eliminating Waste in the Healthcare System
What Data Is Needed To Support Population Health Management?
In our series of blog postings on the topic of Population Health Management, we have discussed how to define populations in Analytics for Population Health Management, and we have looked at the types of analytic tools available for analysis of populations in
Identifying Appropriate Metrics For Population Management
For many reasons, including the advent of the Affordable Care Act, Population Health Management is gaining increased attention from healthcare organizations. A population health initiative has the promise to make care proactive, better coordinated and more customized for the population. A previous blog posting – Analytics for Population Health Management – outlined how populations are … Identifying Appropriate Metrics For Population Management
PHI and APCDs
As more and more states create APCDs, their uses are expanding and evolving. Data generated by APCDs are being used to generate disease, injury, chronic condition, and utilization rates across demographic and geographic settings, as well as by payer type. States are also contemplating linking administrative claims data with clinical data in order to better … PHI and APCDs
