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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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Provider network optimization – Finding value in the details
Timely access to healthcare services is an important enabler of positive health outcomes. Access to care remains a significant challenge in the United States where, historically, approximately 16% of adults Americans have reported long wait times and difficulty getting appointments for routine care as soon as needed. Demand for healthcare services has grown over the … Provider network optimization – Finding value in the details
Network Optimizer
The Milliman Network Optimizer empowers healthcare organizations and regulators to build and manage high-performing networks with confidence.
Breaking the cycle: Analyzing avoidable ER trips and what can be done about them
This study examines patterns and drivers of Emergency Department utilization in the United States by applying the NYU Emergency Department Algorithm to a large, multi-year claims dataset to identify potentially avoidable visits and populations that could benefit from targeted care management interventions.
Milliman MedInsight powers 2026 value-based care with ONC eCQM certification and next-generation clinical data integration
Seattle, WA — January 20, 2026 — Milliman MedInsight® (MedInsight), a leading healthcare data and analytics division of Milliman, is entering 2026 with accelerating momentum in value-based care. Milliman MedInsight has earned Office of the National Coordinator for Health Information Technology (ONC) certification for electronic Clinical Quality Measures (eCQM) under the Health IT Certification Program. … Milliman MedInsight powers 2026 value-based care with ONC eCQM certification and next-generation clinical data integration
Q&A: How data analytics can drive improved outcomes and efficiency in maternity care
Across the healthcare system, improving outcomes while managing the total cost of care remains a critical challenge—especially in maternal health. Maternal mortality rates, comorbid conditions, and persistent disparities have placed increased focus on the quality, accessibility, and effectiveness of maternity care. As organizations work to deliver safer pregnancies and healthier births, understanding the drivers of … Q&A: How data analytics can drive improved outcomes and efficiency in maternity care
Optimizing provider networks: Strategies for access, compliance, and performance
Building a strong, compliant provider network is more important, and more complex than ever. Join our webinar to see how the new Milliman Network Optimizer helps health plans, health systems, and regulators streamline network management, ensure access and adequacy, and drive better outcomes for patients. In this session, you’ll learn how to: Unlock insights from … Optimizing provider networks: Strategies for access, compliance, and performance
