Performance benchmarking

Healthcare performance benchmarking is the process of comparing an organization’s clinical, financial, operational, and population health performance against peer groups, industry standards, or its own historical results. It shows how the organization performs in areas such as cost, utilization, quality, and outcomes, where it leads or falls behind, and where to focus improvement efforts. MedInsight supports healthcare performance benchmarking by pairing deep healthcare analytics expertise with robust benchmarking capabilities, helping organizations compare performance, uncover meaningful variation, and identify actionable opportunities for improvement across cost, quality, utilization, and population health.

Healthcare organizations can benchmark provider performance by comparing physicians, practices, or facilities across key measures such as cost, utilization, quality, outcomes, coding patterns, and patient population characteristics. This helps organizations identify variation in performance, understand what is driving it, and pinpoint opportunities to improve efficiency, quality, and overall value.

MedInsight helps organizations benchmark provider performance with analytics that bring together claims, clinical, and operational data. Organizations can assess variation across providers, specialties, and populations; support provider engagement strategies; and identify opportunities to improve cost, quality, and utilization performance. MedInsight GlobalRVUs measures each provider’s unit price and resource use on a common scale that accounts for case mix and severity. It assigns relative value units across hospital, physician, DME, lab, and pharmacy services. Because GlobalRVUs measures cost and efficiency, a complete provider evaluation should also consider quality, access, and breadth of services.

MedInsight Benchmarks draws on a Milliman research database that combines commercial contributor data with public data sources. Milliman clinical and actuarial experts use it to develop national baseline benchmarks and the adjustment factors applied for demographics, geography, benefit design, risk profile, and degree of health management.

Depending on the benchmarking use case, these datasets may be complemented by additional clinical, demographic, and population health information to enable more meaningful comparisons and deeper performance insights. Bringing these data sources together helps organizations benchmark trends, identify variation, and better understand drivers of performance across the healthcare continuum.

Hospital benchmarking data lets healthcare organizations compare performance across facilities, service lines, and patient populations, including inpatient and outpatient experience against expected values, to identify variation, trends, and opportunities for improvement. MedInsight Benchmarks shows where admissions by diagnosis or procedure family exceed expectations, and GlobalRVUs shows where a hospital’s unit price and length-of-stay efficiency differ from its peers after adjusting for case mix and severity.

Provider performance benchmarking gives healthcare organizations a clearer, data-driven view of how providers compare across cost, utilization, quality, and outcomes. By evaluating performance against internal peers, external benchmarks, or historical trends, organizations can identify which providers deliver efficient, high-quality care and which may represent opportunities for improvement. Consistent measures of unit price and efficiency give payers and providers a factual basis for negotiation. With GlobalRVUs, organizations can compare reimbursement levels, assess the effect of new contract terms, identify cost-efficient providers for tiered or narrow networks, and establish the unit cost baseline for bundled payment and total cost of care arrangements.

Healthcare organizations should look for benchmarking tools that provide reliable, relevant, and actionable insights across cost, utilization, quality, and population health. The most effective tools do more than surface data; they help organizations compare performance meaningfully, understand variation, and identify opportunities to improve decision-making and outcomes. To do that, the software should rest on a credible reference dataset, adjust for the population being measured, apply consistent definitions, and integrate with existing systems. It should also let analysts move from a summary view to the detail that explains a variance. The Performance Benchmarking Suite is built on the Milliman Health Cost Guidelines and addresses each of these requirements. Its tools are also designed to work within an organization’s broader analytics environment and support the specific questions it needs to answer.