Operational


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Milliman can provide a variety of operational consulting services to provider organizations managing risk, ranging from medical groups being paid under alternative payment models (APMs) to health systems operating their own insurance entities.

Our operational consultants specialize in designing and helping clients implement the right infrastructure to manage these complex financial arrangements. We have a number of tools and high-value data sources to supplement our consulting services, such as our administrative benchmarks for staffing, productivity, efficiency, and administrative cost.

Our experience also includes:

  • Developing staffing models and organizational structure to support operations
  • Delivering technology solutions that identify patients for interventions based on predictive analytics
  • Designing care management programs and interventions necessary to optimize provider performance against risk contracts
  • Modeling the financial arrangement of APMs to help provider organizations determine how to optimize their operations for maximized financial results
  • Helping provider organizations file for insurance licenses or work regulators
  • Assisting organizations in compliance with accreditation programs such as NCQA or URAC
  • Analyzing claims data to identify claims leakage and fraud/waste/abuse and recapture overpayments

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