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Measuring how GLP-1 medications impact the total cost of care
Flexible analytics are valuable tools to inform the management of costs and outcomes for therapies such as glucagon-like peptide-1 (GLP-1) drugs, having a significant impact on payer spending and trend. This paper summarizes central themes and provides illustrative examples from Milliman’s GLP-1 Impact Dashboard suite of analytics to facilitate the strategic management of GLP-1-related care. … Measuring how GLP-1 medications impact the total cost of care
Expanding value-based care: The essential role of specialists in long-term success and patient outcomes
Value-based care (VBC) is reshaping the healthcare landscape by focusing on improving patient outcomes while keeping costs under control. Unlike fee-for-service (FFS) reimbursement, this approach prioritizes quality rather than quantity, aiming to reward effective treatments and preventative strategies that can lead to healthier communities and more sustainable healthcare spending. Traditionally, VBC initiatives have zeroed in … Expanding value-based care: The essential role of specialists in long-term success and patient outcomes
Navigating population health with clarity: Dr. Kodama’s expert tips for success in value-based healthcare
The shift toward value-based care (VBC) is transforming how services are delivered, focusing on improving patient outcomes and engagement while reducing costs. Success in this model depends on understanding your population, managing their health proactively, and coordinating care effectively. Meet Dr. Christopher Kodama, Chief Medical Officer at Milliman MedInsight. With a clinical background in pediatric … Navigating population health with clarity: Dr. Kodama’s expert tips for success in value-based healthcare
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
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>
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HIMSS25: Key trends in navigating uncertainty, interoperability, AI, and cybersecurity
The HIMSS Global Health Conference and Exhibition (HIMSS) has long been a hub for forward-thinking discussions and innovations in healthcare technology. This year, Milliman MedInsight was thrilled to return to HIMSS for the second year in a row. HIMSS stands out as a premier event in healthcare technology, drawing over 28,000 healthcare leaders from 88 … HIMSS25: Key trends in navigating uncertainty, interoperability, AI, and cybersecurity
How Milliman MedInsight helped Advanced Health integrate EHR data for state reporting
In this video, Advanced Health Director of Social Determinants of Health, Amanda McCarthy, describes how partnership with Milliman MedInsight helped the organization through a rocky transition to incorporating EHR clinical data into the quality measure reporting required for state funding. As a coordinated care organization (CCO) Advanced Health’s mission depends on its ability to accurately … How Milliman MedInsight helped Advanced Health integrate EHR data for state reporting
How a Michigan PHO uses Milliman MedInsight for population health metrics and value-based care
In this video, the manager of population health and analytics for a Michigan contract provider serving a population mostly living below the poverty line describes how Milliman MedInsight analytics drives the work she does to ensure the best care for the organization’s members. By leveraging MedInsight MARA risk scores and Health Cost Guidelines (HCGs), the … How a Michigan PHO uses Milliman MedInsight for population health metrics and value-based care
Advanced Health uses clinical data and Milliman MedInsight to boost performance and close care gaps
In this video, Advanced Health’s Director of Social Determinants of Health, Amanda McCarthy, describes how collaboration with Milliman MedInsight enables the organization to leverage population health data to better serve its population. As a Medicaid clinical care organization (CCO) serving a diverse population on the southern Oregon coast, Advanced Health uses Milliman MedInsight monthly reports … Advanced Health uses clinical data and Milliman MedInsight to boost performance and close care gaps
The importance of clear provider groupings in healthcare service analysis
Any organization operating in the healthcare space will almost inevitably find itself at some point making use of a market share or service concentration analysis. There are any number of ways one might potentially approach the analysis, each with attendant questions. Armed with clear definitions and a thoughtful approach to quantifying one’s findings, one can … The importance of clear provider groupings in healthcare service analysis
Milliman MedInsight launches comprehensive Risk Adjustment Platform for enhanced performance
New Risk Adjustment Platform boosts accuracy and efficiency, enhancing patient outcomes, plan performance, and revenue SEATTLE, WA – March 10, 2025 – Milliman MedInsight® (MedInsight), a leading provider of healthcare data and analytics, announced today the launch of a comprehensive, end-to-end risk adjustment workflow solution. The new Milliman MedInsight® Risk Adjustment Platform leverages industry expertise … Milliman MedInsight launches comprehensive Risk Adjustment Platform for enhanced performance
