Value-based care analytics software for ACOs and providers
The Milliman MedInsight (MedInsight) VBC Platform is a comprehensive value-based care software solution that supports ACO and provider organizations moving from volume-based to value-based care. It brings together ACO analytics, contract and financial performance reporting, population management and care delivery insight, and advanced analytics for your own teams, so you can improve care coordination, quality, and cost effectiveness across every risk arrangement you hold.
The challenge
Advancing to value-based care with fragmented systems
The move from fee-for-service to value-based care changes what an organization has to be able to see. Care management, performance tracking, contract reporting, and financial forecasting all become connected problems, yet most organizations approach them with tools that were never designed to work together.
Patient data sits apart from care protocols. Payer reporting arrives in inconsistent formats and stops short of the detail needed to act. Analysts leave the platform to do the analysis that matters. The result is effort spent assembling a view of performance rather than improving it, and decisions made later than they needed to be.
Costs and utilization you cannot trace to a driver
Higher-cost services used where lower-cost care would serve
Care gaps and coding gaps found too late to close
High-risk patients identified after the intervention window
The solution
Value-based care software built on a single data foundation
One platform, from population insight to contract settlement. The MedInsight VBC Platform combines Milliman’s actuarial expertise, proven technology, and claims data enriched with groupers, benchmarks, and risk adjusters into one environment, so clinical, financial, and analytics teams work from the same numbers.
Whether you participate in the Medicare Shared Savings Program, LEAD, a CMS episode-based model such as CJR-X, or commercial and Medicare Advantage risk arrangements, the platform adapts to the contracts you hold.
Managing the performance year
Financial performance management
View performance across contracts against Milliman benchmarks, set individual targets, and track progress through the performance year rather than after it.
Condition and population management
See populations, subpopulations, and individuals across the care continuum, stratify by risk, and direct outreach where it will change the outcome.
Quality measures and care gaps
Find and close quality and risk coding gaps to improve scores, support accurate reimbursement, and protect performance.
Where cost and variation live
Provider performance and efficiency
Assess providers on key quality indicators, identify inefficiency and waste, and resolve results to the NPI, TIN, or clinic so savings can be attributed fairly.
Network leakage
Identify high-leakage services by category and guide patients toward in-network providers to improve continuity and control costs.
Post-acute care
Analyze episodes with attention to anchor hospitalization DRGs, broken down by skilled nursing, home health, and other post-acute categories.
Start where you are
Value-based care software applications that grow as your risk grows
No two organizations arrive at value-based care the same way. For some, taking risk is new. Others have carried it for years and cannot get at their own data. Tell us where you are and we will point you at the part of the platform that matters now.
Entering risk
First shared savings agreement, or first mandatory CMS model
Managing agreements
Several contracts, inconsistent payer reporting, uncertain settlements
Growing the network
Deciding which providers to add, keep, or hold accountable
Building your own
In-house analysts and data scientists who need the underlying data
Every customer starts with the same core platform, and each application reads from the same enriched data foundation.
MedInsight VBC Platform
VBC Analytics
Custom analysisAdvanced, customizable analysis on claims aggregated across payers, enriched with analytic groupers and methodologies and run through the MedInsight Data Confidence Model. Drill from a high-level gap to the benchmark underneath it.
Supplemental solutions that build on your investment
Accelerate VBC decisions with MIKE
Accelerate VBC decision-making with MIKE, the MedInsight Knowledge Engine, an AI-powered assistant that delivers trusted answers grounded in MedInsight content, analytics, and workflows.
MedInsight overview
Trust your data and accurately price risk
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 is 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.
Let's talkWhat clients say
In their words
Start with a clear view of where you stand
A demo walks through your current agreements, data sources, and reporting workflow, and shows you where MedInsight would change the result.
Relevant resources
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 January 2028. The hospitals that win are starting now
CMS has finalized 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 it begins January 1, 2028, as an ongoing program … CJR-X starts January 2028. 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
From insight to action: What the value-based care survey reveals
Value-based care organizations face a difficult question: whether their teams can act on analytic insight consistently, within the data and workflows they operate each day. The Milliman MedInsight value-based care survey posed that question to a broad range of provider organizations. The responses show that most regard analytics as essential, while their progress toward operational … From insight to action: What the value-based care survey reveals
Beyond the model: How leading organizations will win under CMS LEAD RFA
A recap of our May 7 webinar If you missed our live session, “How leading organizations will win under CMS LEAD RFA,” don’t worry. My colleague Jonah Broulette, Principal and Consulting Actuary at Milliman, and I walked our audience through what’s actually new in CMS’s LEAD model, how it stacks up against MSSP, and the … Beyond the model: How leading organizations will win under CMS LEAD RFA
New report offers a glimpse into how VBC organizations view the role of analytics in their clinical and business goals
With benchmarks tightening and growing pressure to maximize cost and utilization efficiency under the value-based care model, healthcare provider organizations of all sizes are turning to analytics for answers. As part of our 2025 Provider Market Survey, Milliman MedInsight sought input from provider organizations on their analytics priorities and challenges as well as their vision … New report offers a glimpse into how VBC organizations view the role of analytics in their clinical and business goals
From insight to action: Operationalizing physician performance in value-based care
In Part 1 of this series, Physician performance enablement: Engaging providers with actionable insights for ACO success, we explored the foundational elements required to build physician engagement in value-based care (VBC). Engagement creates shared understanding and alignment, but it is only the starting point. Organizations that consistently succeed in VBC move beyond engagement to physician … From insight to action: Operationalizing physician performance in value-based care
