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
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
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
Looking ahead: Preparing for key HEDIS 2026 updates
The National Committee for Quality Assurance (NCQA) has announced several upcoming changes to the Healthcare Effectiveness Data and Information Set (HEDIS®)1, which will impact how organizations measure and report quality of care.2 These updates are designed to enhance accuracy, reflect new clinical guidelines, and address emerging health priorities—but they also require compliance, data management, and … Looking ahead: Preparing for key HEDIS 2026 updates
CMS 2026 Physician Fee Schedule Final Rule accelerates shift to value and risk in Medicare
As CMS unveils its 2026 final rule, the agency is doubling down on value-based care, making two-sided financial risk the organizing principle for Medicare payment and signaling a decisive shift in how performance and accountability will be measured and rewarded. These new policies have far-reaching implications for providers, health systems, and payers. Two-sided risk becomes … CMS 2026 Physician Fee Schedule Final Rule accelerates shift to value and risk in Medicare
