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 October 2027. The hospitals that win are starting now
CMS has proposed 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 if finalized, it would begin October 1, 2027, as … CJR-X starts October 2027. The hospitals that win are starting now
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
Healthcare payer analytics: Challenges, findings, and next steps
Health plans are investing heavily in analytics and artificial intelligence (AI) but are they getting the results they need? That was the central question at Milliman MedInsight’s June 18th webinar: Data-Driven Payer Strategies: Survey Insights and Solutions. Presenters Marcos Dachary (Milliman MedInsight Principal, Chief Market Strategist and General Manager of Payer Solutions), Lauren Piacentini (Milliman … Healthcare payer analytics: Challenges, findings, and next steps
