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Featured Resources
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
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.
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In today’s ever-evolving healthcare landscape, delivering affordable, high-quality care remains a top priority.
Risk Adjustment Platform
For value-based care success, accurate risk adjustment is essential for fair reimbursement and optimal patient care.
From data to strategy: Scaling payer analytics for growth
In a highly competitive payer market, the ability to transform raw data into actionable insights is more critical than ever. Rising healthcare costs, regulatory changes and transformative technology continue to reshape operational priorities. Creating collaborative ecosystems across the enterprise is vital to an organization’s success. Join us for a webinar hosted by Milliman MedInsight, the … From data to strategy: Scaling payer analytics for growth
Preparing for HEDIS 2025 with an integrated risk adjustment solution
Are you ready for HEDIS 2025? Streamline your workflows with an integrated risk adjustment solution Every year, the National Committee for Quality Assurance (NCQA) publishes a detailed list of updates, additions, and deletions for the Healthcare Effectiveness Data and Information Set (HEDIS®).1As one of the most critical sets of performance measures in the healthcare industry, … Preparing for HEDIS 2025 with an integrated risk adjustment solution
Milliman MedInsight wins 2025 Best in KLAS for Data Analytics Platform (Payer)
The Milliman MedInsight Payer Platform achieves top ranking with enhanced data analytics and clinical-claims interoperability SEATTLE, WA – Feb. 18, 2025 – Milliman MedInsight® (MedInsight), a leading healthcare data and analytics division of Milliman, has been awarded 2025 Best in KLAS® for Data Analytics Platform (Payer). KLAS Research, known for its independent evaluations of healthcare technology, … Milliman MedInsight wins 2025 Best in KLAS for Data Analytics Platform (Payer)
Health system’s VBC analytics expert on the value of partnering with Milliman MedInsight
As SSM Health grew from a single state healthcare system to one that covers four states across the Midwest, its data needs grew proportionately. Darrin Dahl, SSM Health’s product owner for value-based care and finance, describes how the organization’s eight-year partnership with Milliman MedInsight has helped build the data infrastructure SSM needs to manage nearly … Health system’s VBC analytics expert on the value of partnering with Milliman MedInsight
