Value-based reimbursement strategy

Milliman advises both accountable care organizations (ACOs) and insurance companies on value-based reimbursement strategy. Our actuaries have extensive experience in understanding and managing risk and revenues from the patient to the system level. We offer assistance in population health management and financial strategy.

Population health management

Milliman’s healthcare actuaries are leading the way in using huge volumes of available claims, electronic health records (EHR), and consumer data to identify patients who could most benefit from medical intervention. Our healthcare actuaries are particularly experienced with high volumes of healthcare data and know what to look for in terms of key metrics that indicate patient health and opportunity for health management—and associated cost savings. These analyses and insights offered by Milliman actuaries can help both providers identify patients for intervention and health systems train and support providers in care management efforts.

Financial strategy

Population health management may be the cornerstone for any ACO, but focusing broadly on care efficiency may not actually lead to better financial outcomes. This can happen for a variety of reasons, including spending too much money on population health programs that do not adequately produce savings or seeing a reduction in net revenue associated with efficiency. Milliman actuaries have extensive knowledge in looking at the big financial picture (and associated revenue/cost streams and risks associated with each) to determine an approach to optimize the relationship between revenues, profits, and risks.

Many ACOs are looking to find additional sources of efficiency, and Milliman technology can help. Two tools that we regularly use in this area are ACO Insight, which helps determine wasteful spending or the possibility of high spending, and MARA, which assigns accurate risk scores to individuals.

Consumers in the healthcare market are focused on purchasing high value/low cost care and are more likely to gravitate to systems that are engaging in these shared risk (and cost reduction) strategies. Milliman consultants assist clients with developing low to moderate risk programs to start and also creating long-term plans for engaging in shared risk strategies while maintaining health revenue and profit margins.