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Increasing costs and complexity—along with new reimbursement models and changing treatment protocols—are putting a strain on providers. With our rich data, innovative technology, and unmatched domain expertise, we can help you improve patient health and care experience while optimizing efficiency.
Outcome- and risk-based payment models are a reality in today’s healthcare market. We have been working with alternatives to fee-for-service reimbursement since their earliest inception and can help you make these approaches not just a reality, but a success.
Regulatory complexity and cost control requirements make Medicaid and Medicare a tricky business for provider organizations. Milliman’s broad perspective and vast data resources help you maximize efficiency while raising the bar for care quality.
Our operational consultants specialize in people, process, and technology to help you manage alternative payment models, staffing, predictive care analytics, regulatory compliance, accreditation, and waste reduction. We help you discover new levels of efficiency so you can focus on better care.
In the shift from fee-for-service reimbursements to value-based contracts, insurance risk is passed to providers. Milliman can advise your company on stop loss coverage to mitigate risk in today’s risk-sharing payment models.
Milliman helps providers in assessing their ability to take on varying amounts of risk.
Hospital margins, occupancy, and Medicaid reimbursement
Program summary, opportunities, risks, and key considerations
For ACOs participating in MSSP, the minimum savings/(loss) rate (MSR/[MLR]) can offer protection against losses.
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…
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.
While data science techniques offer immense potential for risk managers, (re)insurers need a multidisciplinary approach to tackle challenges and ensure successful implementation.
Commercial payment rates for medical services as percentage of Medicare fee-for-service rates
Improving provider network identification could yield improved interpretation of price transparency data and processing burden.
Over the last decade, ACOs have emerged as a major force in the way healthcare is delivered in this country.
Now that CMS requires REACH ACOs to measure and address health equity, providers face a steep learning curve with data analysis.
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.
This paper provides a summary of the key provisions of the price transparency final rule that apply to hospitals.
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.
When confronted with rising costs and shrinking reimbursement, leaders at a hospital in California took a bold step to ensure that they could continue serving the needs of the community in a financially sustainable way.
Discover how accountable care organizations are using data to make healthcare innovation a reality.
Potential impacts of regulatory changes to the Medicare Shared Savings Program (MSSP)—including faster assumption of downside risk for ACOs.
See how we’re helping clients reduce costs and improve patient outcomes.
Milliman’s integrated, customizable software solution for pricing claims based on Medicare allowable fees.
Adopt the healthcare industry’s leading platform for data warehousing and healthcare analytics.
Estimate expected claims costs and model healthcare utilization with Milliman’s Health Cost Guidelines™, an industry gold standard.
Manage Medicare, Medicaid, and commercial risk adjustment with our award-winning suite of tools and data.
Analyze performance against national and regional best practices for strategic deployment of care management resources.
Manage episodes of care under Medicare bundled payment models using the same logic and claims data employed by CMS.
Evaluate relative values of Medicare Advantage program plans using a comprehensive, Excel-based tool.
Leverage complete data, meaningful analytics, and Millman’s ACO expertise to analyze provider performance.
Analyze historical data to inform policy decisions, validate encounter data, understand emerging experience, and more.
Analyze healthcare relative value units (RVUs) across all healthcare services and provider types, using any data set.
Compare and benchmark hospital contracts on a patient-severity adjusted basis.
Demystify payer and provider contract pricing data for better transparency across the industry.
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