Medical management


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Milliman's healthcare consultants offer detailed knowledge of the critical success factors needed to create a world-class medical management program. We are highly experienced in all types of medical management programs. We offer a vast array of international expertise to help our clients determine what will be most effective in their markets. 

Our expertise extends to all types of medical management functions, including inpatient concurrent reviews, post discharge reviews, ambulatory care management reviews, and disease, claims, and underwriting management. 

Our medical management services teams combine a broad healthcare expertise from veteran physicians, nurses, and pharmacists with the financial knowledge of our actuarial staff to balance the clinical, financial, and operational imperatives of healthcare providers and insurers. 

Disease management return on investment 

We offer extensive knowledge of disease management program cost-effectiveness and employ the latest modeling techniques to estimate likely return on investment. Statistical methods used to measure the financial success of chronic disease management programs are often fundamentally flawed, leading to incorrect conclusions and poor policymaking. Our skills in building robust models allow clients to pinpoint problem areas accurately, leading to better resource allocation. We help clients understand which programs are likely to lead to cost savings and which programs should be focused on quality outcomes rather than cost savings.

Operational review experts improve results 

In our operational reviews, a team composed of both actuaries and medical professionals studies the financial and clinical effectiveness of an organization's case management, pre-authorization procedures, and department-level efficiency to determine strategies for improvement.

We guide clients from strategy to implementation 

Our clients carry out the strategies we help them develop. Milliman's consultants assist clients through the entire process, implementing necessary best practices through staffing, training, pay-for-performance programs, and provider profiling. If necessary, we review vendor costs and options and can assist organizations in identifying and negotiating with new vendors. Our implementation is always carefully tracked and benchmarked so our clients can prove the return on their investments.