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OVERVIEW

Milliman provider solutions

Alternative payment models

Alternative payment models

Insight

Milliman providers insight

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White paper

Variation in skilled nursing facility practice patterns: Opportunities exist for more efficient management

There is significant variation in skilled nursing facility (SNF) average length of stay (ALOS) and readmission rates among Medicare fee-for-service (FFS) beneficiaries admitted to a SNF following an acute inpatient hospital stay.

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White paper

Shadow bundles: A big opportunity for MSSP and REACH ACOs

New data provided to accountable care organizations (ACOs) in the Medicare Shared Savings Program (MSSP) and ACO Realizing Equity, Access, and Community Health (REACH) models can provide opportunities for managing hospital and specialist referrals, but the limitations of the data should be carefully considered.

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White paper

Hospital financial results from the FY2022 CMS Medicare cost reports

Hospital margins, occupancy, and Medicaid reimbursement

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White paper

CMS Making Care Primary Model: Should I participate?

Program summary, opportunities, risks, and key considerations

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White paper

MSSP minimum savings/(loss) rates: A double-edged sword

For ACOs participating in MSSP, the minimum savings/(loss) rate (MSR/[MLR]) can offer protection against losses.

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White paper

Interactions between the CIF and the +/- 3% risk score floor and ceiling in ACO REACH

The Coding Intensity Factor (CIF) is intended to establish revenue neutrality in the Realizing Equity, Access, and Community Health (REACH) program and causes all accountable care organizations (ACOs) to pay for increases in program-wide risk scores.

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ARTICLE

Recent changes to ACO REACH financial benchmark methodology to account for PY 2024 fee schedule changes

As the CMS Innovation Center revises how the ACO REACH Rate Book handles performance-year fee schedules, we provide average impact estimates at a state level and background information regarding the change.

Article

Summary of The U.S. Playbook to Address Social Determinants of Health

While data science techniques offer immense potential for risk managers, (re)insurers need a multidisciplinary approach to tackle challenges and ensure successful implementation.

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White paper

Commercial reimbursement benchmarking

Commercial payment rates for medical services as percentage of Medicare fee-for-service rates

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White paper

Price transparency and provider network identification

Improving provider network identification could yield improved interpretation of price transparency data and processing burden.

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Article

Medicare Shared Savings Program: ACO financial results for 2021

Over the last decade, ACOs have emerged as a major force in the way healthcare is delivered in this country.

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Article

ACO REACH: Leveraging data to reach the underserved and address disparities

Now that CMS requires REACH ACOs to measure and address health equity, providers face a steep learning curve with data analysis.

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Article

Provider strategy: Control vs. contracting

Providers are uniquely situated to both direct and/or provide care for those in the healthcare delivery system through establishing their own health plans or contracting with existing payers.

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Article

Price transparency: New requirements and considerations for hospitals

This paper provides a summary of the key provisions of the price transparency final rule that apply to hospitals.

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MedInsight: Trust your data

We know that your decisions are only as good as your data. And your data is only as good as your platform. You can trust the MedInsight platform to get it right.

Preventive Digital Health

HealthIO: Making healthcare preventive, predictive, and participatory

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Medicare Reference Pricer

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MedInsight

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Health Cost Guidelines Suite

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Milliman Advanced Risk Adjusters

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Hospital Performance Index

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Bundled Payment Reporting Interface

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Medicare advantage benchmarking
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Milliman MACVAT (Medicare Advantage Competitive Value Added Tool)

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Milliman ACO Builder

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Healthcare cost modeling
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Dashboard for Research, Insight, and Validation of Experience (DRIVE)

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Healthcare cost modeling
Healthcare cost modeling

GlobalRVUs

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Healthcare benchmarking
Healthcare benchmarking

HECS & RBRVS for Hospitals

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Healthcare analytics
Price transparency analytics

Milliman Price Transparency Solutions for Payers and Providers

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