Know where every contract stands before settlement
Value-based agreements are a growing share of revenue for payers and providers, and the organizations that manage them well are the ones that can see contract performance throughout the year rather than only at reconciliation. Waiting for year-end settlement means discovering shortfalls when little can be done about them, and it leaves finance teams forecasting revenue they cannot yet measure.
VBC Contracts gives payers, ACOs, health systems, and independent physician associations a current, portfolio-wide view of financial performance across every value-based agreement. It applies Milliman’s actuarial methodology to turn various data sources into settlement forecasts, from the full contract portfolio down to individual provider performance.
Four problems VBC Contracts solves
Managing value-based contracts well is difficult for reasons that compound as an organization takes on more risk. VBC Contracts is built to address four of them directly.
Stop rebuilding reports for every payer relationship.
Organizations in multiple agreements receive data from different payers in different formats, which forces teams to build specialized reporting for each relationship.
See past the ACO total to the providers driving it.
Payer reporting often stops at the ACO level, without giving the provider-level detail that allows ACOs to identify high performers in their network.
Predict the timing and size of value-based payments.
Inconsistent and lagging payer reporting makes the timing and size of value-based payments hard to predict.
Verify a payer’s settlement without rebuilding it by hand.
Confirming a payer’s final settlement calculation demands significant analytical effort for each contract’s unique terms and data elements.
How VBC Contracts works
VBC Contracts turns raw payer and provider data into decisions in a repeatable sequence.
Ingest payer data feeds as delivered, drawing on national and regional payer repositories, with no reformatting required from your team.
Apply Milliman’s actuarial methodology to forecast settlement performance and project savings and losses for the current performance year.
Analyze performance at the individual provider group level to identify cost drivers and allocate savings and losses.
Standardize reporting across every agreement so results are comparable regardless of the source format.
Audit settlement calculations against every contract’s actual terms, producing documented evidence for reconciliation.
The result is a current, portfolio-wide view of financial performance that teams can act on throughout the year rather than at settlement alone.
Who uses VBC Contracts
| If you’re a… | You’ll use VBC Contracts to… | Side |
|---|---|---|
| Chief Financial Officer | Forecast year-end settlements, model downside risk, and stabilize value-based revenue across the contract portfolio | Provider |
| VP of value-based care or Contract operations | Compare performance across contracts and negotiate with accurate, current data | Provider |
| Analytics or Data leader | Unify payer and provider data in one source of truth and reduce ad hoc modeling | Both |
| Payer contracting team | Design new risk arrangements and model their financial implications before presenting terms, with Contract Builder | Payer |
| Payer VBC program administrators | Provide detailed VBC reporting to program participants throughout the year | Payer |
| Consultant | Build and share detailed settlement and risk scenarios for clients, and export to Excel | Both |
What VBC Contracts delivers
Project settlement performance across years
Calculate and compare settlement performance across past, present, and future years, spanning fee-for-service and risk models, including MSSP, LEAD, and custom payer-provider contracts, in all lines of business.
Contract Builder
Configure a proposed contract’s risk-sharing terms, benchmarks, and attribution, then project its performance for the coming year using historical data.
Model cost-reduction scenarios
Model cost-reduction scenarios across your risk contracts, and export results to Excel for further analysis. Payer contracting teams can run the same scenarios to test proposed arrangements before presenting terms.
Risk-unit-level detail
Monitor performance at the NPI, TIN, or clinic level to identify who is driving results and distribute savings and losses equitably among participating providers.
Standardize every payer feed
Process each payer’s data feed as delivered and produce consistent reporting across every agreement, drawing on national and regional payer repositories.
Audit the settlement against actual contract terms
Produce settlements aligned with actual contract terms, giving both parties documented evidence when payer-provided figures diverge.
Getting started
Getting started requires your payer data feeds, which VBC Contracts processes as delivered. MedInsight provides structured implementation and dedicated onboarding support, and scenario results export to Excel so teams can continue working in familiar tools during the transition. The application’s security posture is anchored in HITRUST certification, SOC 2-aligned controls, and HIPAA compliance.
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
Innovation Spotlight Series: Value-Based Care Contracts
The Milliman MedInsight Innovation Spotlight is a quarterly, client-exclusive webinar series hosted by our Product Development team, featuring live demonstrations and expert insights on the latest product innovations addressing today’s payer and provider healthcare analytics challenges. This Innovation Spotlight focuses on Milliman MedInsight VBC Contracts, a solution that helps healthcare organizations manage value-based care arrangements … Innovation Spotlight Series: Value-Based Care Contracts
2024 MSSP success: How Milliman MedInsight VBC solutions help ACOs outperform national averages
Every summer, the Centers for Medicare & Medicaid Services (CMS) announces settlement results for the Medicare Shared Savings Program (MSSP), an update that Accountable Care Organization (ACO) leaders, analysts, and policy experts eagerly anticipate. The MSSP results are more than just numbers in a report; they reflect how well ACOs are delivering value-based care (VBC) … 2024 MSSP success: How Milliman MedInsight VBC solutions help ACOs outperform national averages
