Milliman MedInsight Launches Comprehensive Risk Adjustment Platform for Enhanced Performance

New Risk Adjustment Platform boosts accuracy and efficiency, enhancing patient outcomes, plan
performance, and revenue

SEATTLE, March 10, 2025 /PRNewswire/ — Milliman MedInsight^®,  a leading provider of healthcare data and analytics, announced today the launch of a comprehensive, end-to-end risk adjustment workflow solution. The new Milliman MedInsight^® Risk Adjustment Platform leverages industry expertise and AI-driven technology for improved risk workflow and clinical documentation. This powerful solution enables healthcare organizations to confidently track performance and better manage financial risks.

“Risk adjustment accuracy is becoming increasingly important as Medicare ACOs (including those participating in Medicare Shared Savings Program (MSSP) and ACO REACH) and Medicare Advantage (MA) plans continue to grow. These programs rely on accurate risk assessment to ensure that health plans and providers are fairly compensated for the care they deliver,” said Noah Champagne, Milliman Principal and Consulting Actuary.

The Milliman MedInsight Risk Adjustment Platform offers several key benefits:

• Unified health records from all major national networks and direct APIs to ensure no critical information is missed.
• Claims-medical record integration to bridge the gap between claims and medical records, streamlining workflows, improving documentation accuracy and enhancing response tracking.
• Seamless system integration with existing systems and workflows to enable easy storage, retrieval, and future access to queries and reports.
• Enhanced coding compliance to identify isolated errors versus systemic provider issues to ensure accurate coding and targeted training.
• Proactive care identification to quickly pinpoint beneficiaries who may benefit from additional care (e.g., in-home care visits) to improve Star ratings and health outcomes.
• Detailed insights into provider quality, financial performance, and risk levels down to the individual NPI, powered by the Milliman ACO Builder and Milliman Medicare Advantage Network Intelligence (MANI), along with quarterly lagged Medicare national data.
• Peer comparison tools that leverage our ability to access comprehensive Centers for Medicare and Medicaid Services (CMS) data to gain a competitive edge.

The new Milliman MedInsight Risk Adjustment Platform provides easy implementation as well as integration with current workflows, along with support from clinical coders and clinicians to ensure quick market impact.

“The Risk Adjustment Platform enables us to fully achieve our vision of tackling the complexities and coordination challenges between providers and patients,” said Marcos Dachary, Chief Market Strategist of Milliman MedInsight Payer Solutions. “The combination of MedInsight’s actionable intelligence and data enrichment platform with clinical and documentation workflows will create a comprehensive solution that is truly unique and unmatched in the market. This marks a significant step forward in helping customers meet regulatory requirements and enhancing the quality of care they provide to their patients.”

MedInsight will be showcasing its Risk Adjustment Platform at the upcoming RISE National 2025 Conference in San Antonio, Texas. Visit MedInsight at Booth 201 or online for more information.

About Milliman MedInsight

Founded in 1998, Milliman MedInsight^® is a leading provider of healthcare data and analytics, trusted by over 300 payers, providers/ACOs, employers, and government agencies worldwide. Our comprehensive suite of analytics and data solutions empowers organizations to leverage healthcare data for informed decision-making and improved clinical and financial outcomes. With deep industry expertise and advanced technology, we deliver actionable insights into healthcare utilization, costs, quality, and performance. From risk management to value-based care, Milliman MedInsight empowers stakeholders to navigate the complexities of the healthcare landscape and achieve sustainable success.

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SOURCE Milliman MedInsight