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Under CJR-X, quality decides more than cost: Two former CMS officials on what the earlier bundles reveal
Key Highlights Introduction › Interview › What this means for your hospital › With the CJR-X final rule now released in July 2026, the first mandatory, nationwide episode-based payment model for lower extremity joint replacement is set to begin on January 1, 2028. For most acute care hospitals, participation is now settled and required, and … Under CJR-X, quality decides more than cost: Two former CMS officials on what the earlier bundles reveal
Mitigating the impact of high-cost claimants: A payer analytics approach to total cost of care
It has long been understood that a relatively small portion of any covered population accounts for a disproportionately large share of healthcare spending. A 2025 study by the Employee Benefit Research Institute (EBRI), which examined 13.1 million individuals with employer-sponsored health coverage in 2022, found that the highest-cost 20% of members were responsible for 84% … Mitigating the impact of high-cost claimants: A payer analytics approach to total cost of care
Why VBC still fails for mature organizations: What actually separates high performers
Value-based care (VBC) has moved well beyond experimentation. For many healthcare organizations, value-based contracts now represent a significant share of revenue, risk exposure, and strategic focus. The industry has largely resolved the question of whether to participate in these models. What remains unresolved is how to manage them most effectively. Increasingly, a common source of … Why VBC still fails for mature organizations: What actually separates high performers
CJR-X starts January 2028. The hospitals that win are starting now
CMS has finalized the first nationwide expansion of an episode-based payment model, and by its own account the largest such model in Medicare’s history: a mandatory program covering lower extremity joint replacements (LEJR). It is called CJR-X, short for Comprehensive Care for Joint Replacement Expanded, and it begins January 1, 2028, as an ongoing program … CJR-X starts January 2028. The hospitals that win are starting now
Turn total cost of care strategy into measurable action
Healthcare payers are under growing pressure to reduce costs while managing rising utilization, unit cost, pharmacy spend, and medical expense trends. But analytics alone are not enough. To create measurable impact, health plans need trusted data, actuarial alignment, enterprise governance, and a repeatable process for turning insights into action. In this case study, see how … Turn total cost of care strategy into measurable action
The decade of full risk starts now: Four workflows separate ACOs ready for it
The conditions for value-based care (VBC) have just shifted, as stronger financial results, improved data usability, and new long-term CMS incentives reshape what it takes for Accountable Care Organizations (ACOs) to compete and succeed. ACOs have had access to Centers for Medicare & Medicaid Services (CMS) claims data for years. What has made the difference … The decade of full risk starts now: Four workflows separate ACOs ready for it
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Total Cost of Care, simplified: Turn data into savings
To understand performance opportunities and reduce costs, you need robust clinical, financial, network, and eligibility data, and credible, peer-matched benchmarks. Learn how the MedInsight Platform brings together all the information you need to see the whole picture behind your Total Cost of Care.
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
Milliman MedInsight integrates AI and next-generation analytics to strengthen value-based care decision-making
Seattle, WA — March 3, 2026 — Milliman MedInsight® (MedInsight), a leading healthcare data and analytics division of Milliman, announced a series of ongoing enhancements to its Value-Based Care (VBC) Platform®, reinforcing its commitment to helping payers, providers, and accountable care organizations navigate the increasing complexity of value-based payment models. Built on the Milliman MedInsight … Milliman MedInsight integrates AI and next-generation analytics to strengthen value-based care decision-making
Milliman MedInsight earns Solutions Partner with certified software designation for Healthcare AI across all Microsoft Marketplace solutions
SEATTLE, Wash. — March 2, 2026 — Milliman MedInsight (MedInsight), a leading provider of healthcare data and analytics solutions, and division of Milliman, today announced it has earned the Microsoft Solutions Partner with certified software designation for Healthcare AI within the Microsoft AI Cloud Partner Program. This designation recognizes Milliman MedInsight’s healthcare analytics solutions for … Milliman MedInsight earns Solutions Partner with certified software designation for Healthcare AI across all Microsoft Marketplace solutions
