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Looking ahead: Preparing for key HEDIS 2026 updates
The National Committee for Quality Assurance (NCQA) has announced several upcoming changes to the Healthcare Effectiveness Data and Information Set (HEDIS®)1, which will impact how organizations measure and report quality of care.2 These updates are designed to enhance accuracy, reflect new clinical guidelines, and address emerging health priorities—but they also require compliance, data management, and … Looking ahead: Preparing for key HEDIS 2026 updates
CMS 2026 Physician Fee Schedule Final Rule accelerates shift to value and risk in Medicare
As CMS unveils its 2026 final rule, the agency is doubling down on value-based care, making two-sided financial risk the organizing principle for Medicare payment and signaling a decisive shift in how performance and accountability will be measured and rewarded. These new policies have far-reaching implications for providers, health systems, and payers. Two-sided risk becomes … CMS 2026 Physician Fee Schedule Final Rule accelerates shift to value and risk in Medicare
In case you missed it: Top webinars of 2025
Milliman MedInsight webinars this year have drawn from a broad array of healthcare analytics experience and expertise. From healthcare executives embarking on ambitious strategies for improving care delivery across diverse networks to analytics engineers sharing best practices for modernizing data infrastructure, we covered it all in 2025. Here is an overview of our most watched … In case you missed it: Top webinars of 2025
2025’s breakout whitepapers: The ideas that led the conversation
In 2025, a year in which the industry continued to expand on the promise and potential of the seismic shift toward value-based care, our most widely read whitepapers focused on analytics driving strategic growth and cost savings. Milliman MedInsight whitepapers have explored everything from the cost and efficacy of specific drugs to the changing patterns … 2025’s breakout whitepapers: The ideas that led the conversation
Best of 2025: Top healthcare analytics insights shaping the year ahead
As healthcare organizations grapple with rising costs, evolving regulations, and the shift toward value-based models, analytics has emerged as the foundational pillar for transformation. Throughout 2025, three themes emerged: value-based care (VBC), AI-driven analytics, and payer analytics innovation. We rounded up the following top posts from the year to offer guidance, industry data, thought leadership, … Best of 2025: Top healthcare analytics insights shaping the year ahead
Beyond compliance: Turning CMS’s TEAM Model into a competitive advantage
In January 2026, the Centers for Medicare & Medicaid Services (CMS) will launch the Transforming Episode Accountability Model (TEAM), requiring many hospitals to participate in bundled payment programs for select surgical episodes. This is more than a reimbursement change, it’s a readiness test for value-based care. TEAM will challenge hospitals to achieve tighter financial, clinical, … Beyond compliance: Turning CMS’s TEAM Model into a competitive advantage
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Applying AI to real-world risk analytics— tales from the Innovation Portal and beyond
Healthcare organizations are under increasing pressure to streamline analytics, support cloud strategies, and deliver insights faster—all while managing complex data environments. Milliman MedInsight has developed an AI assistant within its new digital workspace, the Innovation Portal, to help address these challenges by providing a flexible, secure space for users to analyze data using familiar tools … Applying AI to real-world risk analytics— tales from the Innovation Portal and beyond
CMS 2025 RADV audit expansion: Key changes and what they mean to MA plans
In a significant move announced on May 21, 2025, the Centers for Medicare & Medicaid Services (CMS) revealed plans to initiate annual Risk Adjustment Data Validation (RADV) audits for all Medicare Advantage (MA) plans. In this memo, CMS Administrator, Dr. Mehmet Oz, is quoted as saying “We are committed to crushing fraud, waste and abuse … CMS 2025 RADV audit expansion: Key changes and what they mean to MA plans
Optimizing outcomes: Leveraging analytics for provider performance in value-based care
Success in value-based care (VBC) depends on providers working together to deliver high-quality, cost-effective care. However, without access to the right data, they’re forced to navigate VBC challenges without a clear path forward. Join Milliman MedInsight and Genesys PHO for an interactive webinar where we’ll uncover how advanced performance analytics can reveal focused improvement opportunities, … Optimizing outcomes: Leveraging analytics for provider performance in value-based care
Build the right data stack: How to integrate clinical and claims data for actionable intelligence
Best practices for processing clinical and claims data to support modern analytical and reporting needs Healthcare organizations are increasingly challenged to extract value from vast and varied data sources, especially as clinical and claims data become central to decision-making, regulatory compliance, and value-based care initiatives. Yet, the complexities of processing, integrating, and standardizing these data … Build the right data stack: How to integrate clinical and claims data for actionable intelligence
Measuring the unseen: Differentiation in health system services
Some health systems offer comprehensive services, while others are narrower in scope. Understanding service differentiation gives organizations important strategic insight. In this whitepaper, our goal is to illustrate one approach organizations may leverage in thinking about and quantifying a health system’s differentiation in its various markets.
Introducing our new eBook: The intersection of clinical data integration and value-based care: Strategies for success
As healthcare pivots towards value-based care (VBC), providers face intricate challenges centered on enhancing patient outcomes while managing costs effectively. This shift demands not only a change in approach but also a sophisticated integration of healthcare data to drive meaningful improvements. At the heart of VBC lies the seamless integration of Electronic Health Record (EHR) … Introducing our new eBook: <em>The intersection of clinical data integration and value-based care: Strategies for success</em>
