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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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AI-driven healthcare analytics: What to expect in 2025
As healthcare technology advances rapidly, artificial intelligence (AI) and generative AI (Gen AI) are making significant strides in improving operational efficiencies in both care delivery and financing. From automating routine tasks to enhancing the precision and speed of data analysis, AI and Gen AI are paving the way for a more efficient and patient-centric healthcare … AI-driven healthcare analytics: What to expect in 2025
Cascading impact of unnecessary or low-value care services
Research suggests that almost 30 percent of all healthcare in the United States is unnecessary or wasteful. In this whitepaper, we explore the unintended consequences of unnecessary medical testing and treatment and offer suggestions for patients and clinicians to reduce the potential for these harms without compromising care. The Milliman MedInsight® Health Waste Calculator is … Cascading impact of unnecessary or low-value care services
Milliman MedInsight releases Value-Based Care Platform with advanced EHR integration and contract management capabilities
Upgraded platform empowers ACOs with comprehensive data insights and predictive analytics for optimal care delivery and financial performance SEATTLE, WA – Feb. 25, 2025 – Milliman MedInsight® (MedInsight), a leading healthcare data and analytics division of Milliman, introduces its upgraded Value-Based Care (VBC) Platform®. Built on the Milliman MedInsight Health Cloud, the VBC Platform is … Milliman MedInsight releases Value-Based Care Platform with advanced EHR integration and contract management capabilities
Genesys PHO: Optimizing patient risk stratification and clinical outreach
Genesys PHO, a Michigan-based physician hospital organization and partnership between primary care physicians and investors Ascension and Henry Ford, serves about 120,000 patients. Recently, the organization began working to improve outcomes using risk stratification to improve provider performance. Working with analysts and leveraging the risk stratification tools in the Milliman MedInsight VBC Platform, nurses embedded … Genesys PHO: Optimizing patient risk stratification and clinical outreach
