Healthcare data insights and analytics for payers

Harness payer-focused capabilities with unparalleled insights, data-driven decisions, and Milliman benchmarks to support financial, clinical, provider, and employer reporting so you can become an analytics center of excellence.

MedInsight Healthcare Payer Data Analytics

Who MedInsight serves

Commercial plans

Gain a competitive advantage and trust your data again by aggregating and benchmarking claims data for actionable insights to reduce costs, waste, and financial risk, while increasing member satisfaction and employer group retention.

Medicare Advantage plans

Trust your data again by aggregating and benchmarking claims data for actionable insights to reduce the higher cost and risk of serving this population, while optimizing risk adjustment capabilities.

Medicaid plans

Improving health outcomes for your most underserved, at-risk members with data you can trust so that you can identify actionable insights to reduce costs, waste, and financial risk.

MedInsight Payer users

Data Analysts

Data analysts

Explore aggregated claims data quickly that integrates with your SQL and business intelligence (BI) tools. Custom dashboards enable information consumers with more complex analytics displayed with intuitive visuals.

Data Scientists

Data scientists and engineers

Fully engage with aggregated claims data using R, Python, Scala, and SQL. Access MedInsight’s Referential Database for research, testing/training ML models, and utilize APIs to facilitate interoperability.

Information Consumers

Information consumers

Experience visual reporting and the ability to slice-and-dice claims data without needing SQL experience so you can view financial and operational performance and identify savings and risk reduction opportunities.

Financial Users

Financial users

MedInsight financial analytics support actuaries, finance professionals, and medical economics teams with key metrics and benchmarks. MedInsight identifies cost savings opportunities with playbooks to implement them.

Clinical Users

Clinical users

Identify care gaps and opportunities to right-size utilization, improve health outcomes, and increase savings. You can also ingest EMR data from Epic and other systems to optimize care management resources.

Key capabilities for payers

Cost Drivers

Identify cost drivers

Zero in on major cost drivers and savings opportunities such as provider contracting, unnecessary utilization, site of service optimization, and more.

Risk Adjustment

Improve risk adjustment and modeling

Analytics enhance your risk adjustment and risk modeling efforts to improve coding, optimize reimbursement, and prioritize patient care.

VBC Support

Value-based care support

Quickly evaluate the effectiveness of your value-based care programs and assess what is and is not working.

Provider Network

Provider network management

Analyze provider performance, improve contract negotiating positions, leverage price transparency data, and create narrow networks.

Employer Group Reporting

Employer group reporting

Improve retention rates with Employer Group Insights (EGI). Extend visibility to employers and brokers, and demonstrate your value.

Cost of Care

Measure total cost of care

Evaluate total costs across multiple dimensions, enhance your value, and demonstrate your care and quality approaches.

MedInsight Payer platform

Insights

Insights

Identify quality of care improvements, savings opportunities, and ways to lower financial risk – and visually communicate them to stakeholders through the MedInsight reporting interface.

Analytics

Analytics

Perform advanced, custom analysis on claims data that is aggregated across payers, enriched with groupers and metrics, and run through the MedInsight Data Confidence Model.

MedInsight Payer applications

Contracts

Contracts

View financial performance across contracts so you can analyze the likelihood of success by contract, set individual contract targets, and track performance over the year.

Bundles

Bundles

View all services provided to patients, streamline digital tools, and identify cost savings with the MedInsight bundled payment reporting.

MedInsight overview

Trust your data and accurately price risk with MedInsight: relied on by over 300 payers and ACOs since 1997 to aggregate and enrich claims data with county-level benchmarks, risk adjusters, and groupers—all peer-reviewed as part of the MedInsight Data Confidence Model. Your data will be refreshed in days instead of weeks every month so you can identify insights that lead to improved health outcomes, lower cost, and reduced financial risk.

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Testimonials

Best in KLAS Payer Analytics

Best in KLAS for the fifth consecutive year

MedInsight’s platform for healthcare analytics and data warehousing and was once again recognized as the Best in Payer Quality Analytics in the 2023 Best in KLAS: Software and Services report. Best in KLAS awards are determined following extensive evaluations and conversations with thousands of healthcare providers.

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Blogs

Milliman MedInsight Perspective: Driving digital transformation in health plans

Digital transformation in healthcare is not just about adopting newer, faster technologies. It is about fundamentally changing how healthcare is coordinated and delivered. To advance...
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Charting the future: Strategies for healthcare CFOs

Healthcare Chief Financial Officers (CFOs) are increasingly finding themselves at the helm of strategic decision-making that goes beyond financial management. Recent issues, such workforce retention...
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Navigating the challenges: Key priorities for ACOs in the journey to value-based care

In recent years, Accountable Care Organizations (ACOs) have emerged as a recognized force in the shift from fee-for-service models to value-based care. By fostering coordinated...
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