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Milliman MedInsight Launches New Risk Adjustment Platform

In an exciting development for the healthcare industry, Milliman MedInsight, a prominent name in healthcare data analytics, has introduced a comprehensive risk adjustment workflow solution. This innovative platform promises to enhance the accuracy and efficiency of managing patient care, ensuring improved outcomes and financial performance across healthcare organizations.

The launch, which was announced on March 10, 2025, highlights the increasing importance of risk adjustment accuracy—particularly as more Medicare Accountable Care Organizations (ACOs) engage in programs such as the Medicare Shared Savings Program and Medicare Advantage plans. These initiatives demand precise risk assessments to guarantee that health plans and providers receive fair compensation for the services they deliver.

Key Features of the Risk Adjustment Platform

Milliman’s new Risk Adjustment Platform boasts several standout features that are tailored to meet the needs of today's healthcare organizations:

1. Unified Health Records: The platform integrates health records from all major national networks along with direct APIs. This functionality reduces the risk of overlooking critical information that can impact patient care.
2. Claims-Medical Record Integration: The system bridges the gap between claims processing and medical records. This integration streamlines workflows, boosts documentation accuracy, and improves the tracking of responses.
3. Seamless System Integration: Designed to work alongside existing systems, the platform ensures easy storage, retrieval, and future accessibility to vital queries and reports.
4. Enhanced Coding Compliance: By identifying isolated errors and systemic provider issues, it ensures accurate coding and facilitates targeted training to enhance overall compliance.
5. Proactive Care Identification: The platform quickly identifies beneficiaries who may need additional care, such as in-home visits, which can bolster health outcomes and improve Star ratings.
6. Detailed Insights: Organizations will gain in-depth insights into provider quality and financial performance on an individual NPI level, powered by Milliman's ACO Builder and Medicare Advantage Network Intelligence (MANI).
7. Peer Comparison Tools: Access to comprehensive CMS data allows healthcare providers to compare their performance against peers, giving them a competitive edge in the market.

A Significant Leap Forward

Marcos Dachary, Chief Market Strategist for Milliman MedInsight Payer Solutions, expressed the transformative nature of this platform, stating, "The Risk Adjustment Platform enables us to fully achieve our vision of tackling the complexities and coordination challenges between providers and patients." He emphasized how the integration of actionable intelligence and clinical documentation workflows represents an unmatched solution in the healthcare market.

The platform's user-friendly implementation process and integration capabilities are augmented by support from clinical coders and clinicians, ensuring a swift transition and immediate market impact. This is a significant milestone for Milliman MedInsight as they strive to assist customers in meeting regulatory requirements while enhancing the quality of care they provide to patients.

Upcoming Showcase at RISE National 2025

Healthcare stakeholders can learn more about the Milliman MedInsight Risk Adjustment Platform at the upcoming RISE National 2025 Conference, set to take place in San Antonio, Texas. Interested parties are encouraged to visit Booth 201 or check online for more information.

About Milliman MedInsight

Founded in 1998, Milliman MedInsight has become a trusted leader in healthcare data analytics, serving over 300 payers, providers, ACOs, employers, and government agencies globally. Their comprehensive suite of analytics solutions equips organizations with the tools needed for informed decision-making and improved outcomes, offering deep insights into healthcare utilization, costs, and performance. Milliman MedInsight is committed to navigating the complexities of the healthcare landscape, enabling stakeholders to achieve sustained success.