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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
Beyond the diagnosis: The financial toll of cancer amid chronic conditions
Cancer is a leading cause of death worldwide, accounting for nearly 10 million deaths in 2020, or nearly one in six deaths. In the United States, the percentage of adults who have ever been diagnosed with cancer is 10.3% in 2024 and cancer is the number two cause of death across all chronic conditions. Cancer … Beyond the diagnosis: The financial toll of cancer amid chronic conditions
Optimizing the Total Cost of Care with payer analytics
Health plans now operate in a far more complex environment than in past years. With economic uncertainty, shifting market forces, and regulatory changes, there is increasing pressure for health plans to do more than just maintain performance; they must deliver real, measurable value. To succeed in managing the Total Cost of Care (TCOC), health plans … Optimizing the Total Cost of Care with payer analytics
Bridging the gaps: Ensuring provider network adequacy with the Milliman Network Optimizer
Building a provider network that meets adequacy standards is no small feat for healthcare organizations. As regulatory requirements evolve and patient needs diversify, ensuring beneficiaries have timely access to the right providers becomes increasingly complex. Organizations must navigate a maze of compliance benchmarks, analyze vast and often fragmented data, and address gaps across multiple specialties … Bridging the gaps: Ensuring provider network adequacy with the Milliman Network Optimizer
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Risk Adjustment Services for MA Plans
Medicare Advantage (MA) plans face challenges in accurately assessing and managing member health risks, especially as regulations and CMS guidelines change. To ensure fair reimbursement and stay competitive, MA plans need strong risk adjustment strategies and precise documentation of Hierarchical Condition Categories (HCCs), since mistakes can lead to compliance issues and lost revenue. They also … Risk Adjustment Services for MA Plans
Advancing pharmacy management: The impact of biologics, biosimilars, GLP-1s, and data-driven insights
Healthcare costs continue to climb with the average per-person expense rising 6.7%—from $7,378 in 2024 to $7,871 in 2025. This increase is being driven primarily by two categories: pharmacy and outpatient facility care. Pharmacy costs alone grew by 9.7%, while outpatient facility care costs have risen by 8.5%. Collectively, these service areas are responsible for … Advancing pharmacy management: The impact of biologics, biosimilars, GLP-1s, and data-driven insights
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
Elevate your organization’s AI usage: Gen AI in Healthcare webinar
AI is progressing rapidly, and implementing new technologies is becoming increasingly necessary for organizations looking to increase operational efficiency. At MedInsight, we utilize AI to enhance products and services, protect PHI, and deliver faster, better insights for our clients. However, implementing AI is not a straightforward process, and questions often arise such as how can … Elevate your organization’s AI usage: Gen AI in Healthcare webinar
Leading through change: 2025 Trends and 2026 strategies for healthcare analytics
Reflecting on 2025, the year has brought both exciting opportunities and complex challenges in healthcare analytics. Healthcare organizations have been under increasing pressure to manage policy changes, rising costs, and the ongoing transition to value-based care (VBC) while adopting new technologies and AI-driven applications. In this webinar, we will examine the key trends that have … Leading through change: 2025 Trends and 2026 strategies for healthcare analytics
