We help clients address extreme weather and climate risks, market volatility, retirement security gaps, rising health costs, emerging regulatory demands, and the need for data-driven decision-making frameworks. Our tailored solutions deliver clarity and operational resilience.

Milliman has extensive experience applying advanced analytics techniques in our healthcare work, including with Medicare, Medicaid, and ACOs.

ACOs need to see their data in new ways to determine where they can improve, and we help ACOs explore the data they are receiving in useful and customizable ways. We have developed many products and tools that can be leveraged to answer the most common business questions that ACOs have. Milliman understands the differences between common risk contracts and understands how different aspects of those contracts can be important to different ACOs.

Working in tandem with providers, we explore claims and financial data so that we can benchmark, identify anomalies, and perform opportunity estimation. Through advanced analytics and machine learning, we can find areas of waste, discover opportunities for efficiency and savings, and improve decision making. Ultimately, Milliman assists in providing a greater and more diversified understanding of each ACO’s healthcare utilization.

Making the decision to enter a new market, launch a new product, or change benefits can be full of uncertainty. Companies today are concerned they don’t have all the facts or may wonder about the unexpected financial consequences of a decision.

Every day insurers, health plans, and employer groups call on Milliman consultants to help develop new products and bring them to market. From initial plan design and feasibility studies through completing necessary regulatory filings, our knowledge, experience, and tools give us superior resources to handle the task.

Milliman has extensive databases that enable us to price new or unusual products and estimate the cost impact of mandated benefits and limitations. Our consultants draw from diverse backgrounds throughout the healthcare industry to bring you expertise second to none.

We have decades of pricing and product development experience, supported by healthcare data, research, and proprietary tools. Our clients rely on our conclusions and recommendations to create profitable and competitive products.

Milliman assists healthcare clients with a variety of actuarial analyses including rate setting, fee schedule development, budget forecasting and reserving. In addition to performing the underlying analysis Milliman can assist in communicating results to internal and external stakeholders including non-technical audiences.

Plan sponsors face exposure to an ever-increasing level of risk in their duties as fiduciaries and administrators of defined benefit plans. A more dynamic workforce, global competition, and legislative changes are creating new demands and sources of risk that could affect the entire organization.

Milliman's defined benefit plan services come with a demonstrated track record of the highest work quality and successful client relationships. Our approach is to gain a thorough understanding of a client’s organization to help develop unique goals for its retirement plans. To reach those objectives, we bring in a dedicated, cross-functional team of actuaries, administrators, regulatory compliance experts and plan-design professionals, allowing us to respond quickly to client needs.

A proactive approach

One critical component of our work is proactively watching the macroeconomic and regulatory environments for any changes that could have an impact on a plan. We constantly evaluate plans and funding policies to explain problems that could arise, keeping clients up to date and eliminating surprises. Our services include:

• Forecasting each plan’s financial needs using state-of-the-art modeling techniques and software.
• Assisting clients in meeting IRS reporting requirements.
• Providing clients with all information required for financial accounting.
• Communicating plan details to decision-makers and employees using concise, comprehensible language, visual representations, and real-world examples.

Independence

Milliman is independent of and has no financial relationships with outside organizations that would present a conflict of interest. Our income is derived solely from fees for services provided to our clients. This ensures that our advice and counsel is independent and objective.

Accuracy and client satisfaction

We consider accuracy of recordkeeping to be our hallmark. Milliman’s strict peer review process for every project ensures quality control for high-level concepts and conclusions, down to the minutiae of data collection and calculations. Reviewers are familiar with the project, but have not performed significant work on the job.

FLEXIBILITY & CLOUD COMPUTING

With Integrate One, you begin a transformational journey. Your models are easier to keep up to date based on an annual model review against best practices and the latest innovations.

Integrate One allows you to tap into the power and flexibility of the cloud with more scalability and reliability. Results are presented in cloud-hosted reports and dashboards, and by running your models in the cloud you can set yourself on the path for future growth, with the ability to scale resources as your needs and goals evolve.

A single platform approach built on the foundation of Integrate Base, combined with efficient model design, cloud computing, and cloud-hosted reports and dashboards, can help you and your teams get more value from your efforts. Robust SLAs, disaster recovery capabilities, and more precise modeling and valuation processes and results all help increase confidence in accuracy and stability.

MODEL DEVELOPMENT & CHANGE MANAGEMENT

With Integrate Two, in addition to the enhanced service and system functionality of Integrate One, we partner with you to keep your models up to date to the Standard Code, and you receive advice on your modeling and valuation processes.

Integrate Two gives you a higher level of governance with powerful tools to manage and control model change.

Integrate Two provides a highly controlled and governed change management environment, enabling model developers to coordinate a release, work in parallel, define and enforce a process around change, and visually see and resolve conflicts, thereby increasing efficiency and consistency. Integrate Two also provides you with guidance in developing a target operating model (TOM).

COMPLETE TRANSFORMATION

With Integrate Three, you experience a full transformation, propelling you into the twenty-first century with a comprehensive end-to-end solution.

Integrate Three is for organizations that want to reinvent the way they approach financial modeling and reporting. Going far beyond the model governance tools of Integrate Two, Integrate Three provides an automated, end-to-end solution, from initial data integration to advanced reporting and storytelling.

Integrate Three brings together and automates your entire process, from extracting and transforming back-end data to helping actuaries dynamically and efficiently interpret and analyze results.

With Integrate Three, you have a true strategic partner. Our senior management meets regularly with your senior management to define and confirm strategic priorities. During critical production periods (such as quarter-end valuation), your environment is supported 24/7. If the system goes down while your runs are live, the issue will be resolved within an SLA-specified timeline, no matter the time of day.

Identified Data Interpretation for a Panoramic View of Individual Risk

The Irix Suite of data-driven products gives a comprehensive picture of applicant risk for life, disability, long-term care, and Medicare Supplement insurers.

Instant data interpretation for next-level business results

This fully automated underwriting engine will modernize your workflows, add newfound efficiencies, and ensure consistent decisions.

Predictive modeling for mortality and morbidity

Risk Score simplifies underwriting by quantifying the relative mortality risk in life insurance applicants or predicting morbidity in Medicare Supplement applicants.

Interpreted clinical and lifestyle data for instant decisioning

Irix Data Sets include Prescription Data, Medical Data, Credit Data, and Criminal Data, interpreted by the Irix Rules Engine or input into Irix Risk Score.

Real-time prescription histories for insight into underlying conditions

The product that launched a category is still your most comprehensive source of electronic health information.

Medical claims data for vision into provider encounters

See more stubbornly hidden conditions and fewer labs, exams, and APS orders.

Credit attributes for finer risk stratification

This optional data input for mortality Risk Score lets you confidently write more business from slivers of risk segments you would normally hold in doubt.

Criminal histories for a critical layer of protective value

Instantly magnify auto-decline insights and filter out high-risk applicants.

Data-driven hindsight for detecting applicant misrepresentation

Spot more undisclosed high-risk conditions, deny fewer claims, and get a better view of business performance.

Deidentified Data Interpretation for a Broader View of the Group Risk Terrain

Curv is a suite of predictive models that assign a relative risk score to a group of individuals using deidentified prescription histories and medical data. Insurers use Curv for group underwriting, market segmentation, and risk adjustment optimization.

Quote Group Health Insurance More Quickly and Reliably

Curv Group Health empowers health insurers to win the right business at the right rates.

Select the Best Group Life and Disability Risks with Confidence

Curv Group Life & Disability is a predictive model that uses de-identified prescription histories for a group of individuals to produce product-specific risk scores for the group.

Zero in on Target Audiences

Curv Market Segmentation sorts prospects and members into highly accurate risk categories for targeted outreach. Insurers can use this information to make strategic connections that drive better marketing results.

Identify New ACA Plan Members with Likely Uncoded HCCs

Curv Risk Adjustment optimizes ACA reimbursement on new members in their first year and delivers significant benefit-to-cost results.

Milliman ACO Builder quantifies participant-level performance inside and outside your ACO, based on comprehensive data that’s always current. Through Excel or a web-based solution, it helps you improve partnerships with providers and payers to make healthcare more affordable, build the best network for your patient population, and excel in value-based care.

Milliman ACO Builder is more than just a dashboard. It is a full pro-forma projection model with Milliman’s unparalleled ACO expertise and the complete Medicare experience data is built in. You can also connect with the same consultants who created ACO Builder to tailor it to your needs and interpret results for your organization.

Milliman ACO Builder is available for all major Medicare risk programs including:

• Medicare Shared Savings Program (MSSP)
• Direct Contracting (DC)
• Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH)
• Medicare Advantage

Milliman’s ACO Care Management Impact Model (ACO CMIM) allows consultants, medical management staff, and financial analysts to model the impact of care management on healthcare costs and utilization. ACO CMIM enables organizations interested in setting up an accountable care organization (ACO) to establish medical management goals and performance targets that will help achieve desired financial results. They can also carefully analyze operations or the likely outcome of decisions before changes are implemented.

Optimize operations and care management structure

ACO CMIM draws on Milliman’s Health Cost Guidelines database for its comprehensive modeling. Users can determine the costs of their desired care management functions or work to structure care management to meet established financial goals. With this tool, new or existing ACOs can:

• Optimize care management operations and address waste or medically unnecessary healthcare utilization.
• Model a range of effective performance and know whether the organization is meeting goals or is able to improve.
• Analyze operations or the impact of decisions before a change is implemented.
• Determine administrative or staffing costs associated with the desired care management.
• Benchmark their performance against similar ACOs.

Milliman’s ACO Insight reporting interface provides claims data insights to identify opportunities for efficiently managing the cost and quality of care provided to Medicare, Medicaid and commercial ACO populations.

Users can analyze utilization patterns over time and drill into the detail of individual patient cohorts to identify cost savings opportunities. This web-based data visualization tool contains a number of pre-defined data views along with benchmarks, where available. Users can log on to the interface at their convenience and access personalized, comprehensive reports prepared by Milliman.

Insights

Identify quality of care improvements, savings opportunities, and ways to lower financial risk – and visually communicate them to stakeholders through the MedInsight reporting interface.

Analytics

Perform advanced, custom analysis on claims data that is aggregated across payers, enriched with groupers and metrics, and run through the MedInsight Data Confidence Model.

Performance Benchmarking Suite

MedInsight Performance Benchmarking Suite empowers organizations to compare their performance against Milliman’s highly respected benchmarks. With comprehensive metrics and key performance indicators, organizations gain a clear understanding of their strengths, weaknesses, and areas for improvement.

Risk Adjustment Suite

MedInsight Risk Adjustment Suite offers advanced algorithms and predictive modeling capabilities that optimize coding accuracy, identify documentation gaps, and ensure appropriate reimbursement.

Clinical Suite

MedInsight Clinical Suite offers revolutionizes healthcare delivery by empowering organizations with advanced clinical analytics and decision support capabilities. This comprehensive suite enhances clinical decision-making, improves patient outcomes, and drives operational efficiency.

Milliman has the expertise and claims data analytics to support participants in Medicare bundled payment programs, including BPCI, CJR, OCM, and BPCI Advanced.

Dynamic claims interface

Leverage self-service data visualization and guided analytics.

Time saving search tools

Filter data based on time period, attending/operating provider, beneficiary demographic characteristics, or other criteria.

Customized, comprehensive reports

Access dashboards and detailed reports including data insights such as overall episode costs, anchor hospitalizations and related expenditures, post-acute care costs, and many more.

MARA population health models and tools offer person-centric, clinically meaningful risk profiles. Discover risk by health service categories to:

• Analyze acute, chronic, complex, and social drivers of clinical risk
• Segment members by expected cost increase or decrease
• Identify risk of emergency department visit or hospital admission
• Evaluate social and community-specific health risk factors

Industry-leading health risk models enhance predictive analytics

Benefit from the highest overall performance among 11 other claims-based predictive risk models.

Accuracy of Claims-Based Risk Scoring Models (soa.org)

Responsive client services

Engage the team behind MARA directly to help with implementation, technical support, and user training so you can get the most value from your investment. Add Milliman consulting expertise for critical financial applications, including value-based payment, underwriting workflow, care analytics, and predictive analytics.

Flexible licensing

License only the models you need from the extensive MARA Library. Select models based on your organization’s business applications, population types, and available data.

Simple deployment and management

Keep data local with a platform-independent solution that runs on Windows, Linux, and Unix desktop environments, or run in the cloud for maximum performance. You can use MARA through a graphical user interface, batch mode, or APIs for JavaScript, .NET, or MARA Spark API + Databricks.

Consistently updated

Stay current with rapid changes in healthcare coding and treatment thanks to easy code updates for new drugs and diagnosis codes.

Load and process historical data using MARA’s Rolling Risk feature

Select this time-saving feature when processing two or more years of historical data. Observe risk changes over time with this efficient feature.

CREW^™ stands out from the pack with its efficient, flexible Microsoft Excel-based template that uses a single, simple-to-use workbook. The flow of the calculations can be easily understood by actuaries and non-actuaries alike. CREW’s primary asset is its ability to accommodate unusual claim payment patterns, as well as changing enrollments, benefits, unit costs, and other key factors like changes in capitation and provider contracts. The result is a far more accurate estimate.

A better monitoring tool with more accurate estimates

CREW performs a series of actuarial-based claim-reserve calculations using historical, client-specific claims and exposure data. CREW also offers reporting features that make it an exceptional management tool.

CREW can:

• Summarize claims and calculate loss ratios by incurred month, quarter, and calendar year
• Analyze incurred claim trend and reflect seasonal patterns including working day adjustments by service category
• Calculate restated reserve levels using claim run-out data
• Sensitivity-test best estimates against alternative assumptions
• Graph results to better display estimates
• Summarize results several ways to identify patterns and outliers
• Flexible approach supports unique client needs
• CREW uses a dual approach by developing incurred claim estimates based on both claims lag patterns and projections of historical costs on a unit cost basis.

The tool is designed so that the user can easily test and document the sensitivity of different sets of assumptions on the resulting IBNP estimate. This feature is critically important because reserve estimates are often very sensitive to the assumptions used.

Client focus offers timely support

Milliman consultants provide training and ongoing support for CREW users. In our thorough, half-day training session, we give CREW users a comprehensive understanding of how to use this tool, typically using the client’s data as part of the process. Any necessary client-Milliman interaction is seamless and efficient because Milliman uses the same model the client licenses to develop the reserves. Data concerns are eliminated, and advice is easily shared.

Get started

Any entity with claim run-out risks and reserve estimation needs can benefit from CREW. Whether you set reserves for one cohort of claims or many, CREW easily adapts to your needs. Contact us today to find out how CREW can help you develop more accurate reserve estimates and gain a new insight on your business.

CORAL makes navigating the intricacies of cost sharing and actuarial value straightforward. This powerful tool simplifies comparisons between benefit plans, taking the guesswork out of assessing relative cost. CORAL translates complex data into actionable insights, empowering insurers, brokers, and consumers to confidently make informed decisions and supporting more accurate underwriting.

Access anywhere anytime

Harness the power of web-based actuarial software for on-demand analyses.

Stay ahead with data-driven insights

Leverage Milliman’s Health Cost Guidelines for reliable results and access Milliman actuarial services for deeper analysis.

Streamline underwriting processes

Simplify and improve your underwriting tasks with precision-driven software for advanced commercial use cases.

Transform cost relativity analysis

Get faster, more accurate results using powerful relativity software.

Stay compliant and informed

Benefit from a tool that meets regulatory scrutiny while retaining its leading-edge capabilities.

The Dashboard for Research, Insight, and Validation of Experience (DRIVE™) is a business intelligence tool that provides clients a way to visualize and quickly manipulate their summarized historical experience data in relation to other comparative data, such as pricing information or experience from other time periods or geographic areas. Using a web-based application, users can “slice and dice” data by any of the key dimensions loaded into DRIVE, enabling them to identify outliers at a high level and drill into detailed drivers of the outlier to better understand and take corrective action in a timely manner.

DRIVE is flexible; the tool doesn’t require users to hit a specified data format and is not limited to a specified list of dimensions. This allows for easy acceptance of new data and results in a short implementation timeline and quick turnaround times back to states, health plans, providers, and other partners. This quick turnaround allows all parties to see the impact of ongoing changes for further analysis—which has proven to be especially helpful to our clients when crafting policy decisions.

The DRIVE tool provides client and related party personnel the following capabilities:

• Compare encounter and/or fee-for-service claims experience at the service detail level across multiple key high level dimensions.
• Provide a dynamic comparison of multiple data sources at an aggregate level by choosing two data dimensions to split the report.
• Allow users to identify high-level issues and drill into service level drivers.
• Line chart functionality allows users to effectively visualize data over time across various dimensions in the underlying data.
• Bar chart functionality allows users to effectively visualize differences in experience across multiple data dimensions.

DRIVE use cases

• To validate encounter data. Encounter data is crucial to setting capitation rates, monitoring program effectiveness, evaluating health plan performance, and more. Without complete, up-to-date, and accurate encounter data, it is impossible to have a successful managed care program. DRIVE transforms previously static reconciliations into dynamic comparisons of data with drill-down capabilities, allowing states and health plans to work through encounter data quality concerns using the same information. The DRIVE tool allows states, health plans, and other key stakeholders to view summarized encounter data from the state’s data warehouse as well as the health plan-reported experience.
• To provide the data book for purposes of health plan procurement or rate setting. By providing the data book in DRIVE, bidders and contracted health plans can quickly understand the managed care program’s historical enrollment, utilization, and cost information.
• To understand emerging experience. We load emerging fee-for-service and encounter data on a monthly basis into DRIVE for many of our state Medicaid clients so that state Medicaid personnel can quickly understand emerging trends and respond to any questions from health plans or other key stakeholders.
• To compare to historical fee-for-service experience. A key comparison our state Medicaid clients are interested in when setting up a new managed care program is how the emerging experience compares to the fee-for-service experience. DRIVE provides an effective way to compare metrics across multiple key dimensions. DRIVE has allowed us to help identify areas of concern in the emerging encounter experience in a quick and efficient manner so that issues can get communicated and addressed.
• To compare to the underlying benefit expense in the capitation rates. Another key comparison our state Medicaid clients are interested in is how the emerging experience is coming in relative to the underlying benefit expense in the capitation rates experience. DRIVE allows us to identify areas where emerging experience is coming in higher than estimated in the capitation rates. Additionally, it helps answer questions from health plans in an efficient manner.
• To inform policy decisions. DRIVE has provided our state Medicaid clients with the ability to get real-time answers to key questions during policy meetings. DRIVE provides the necessary bridge between policy and data to enable states to make the best decisions in a timely fashion.

In all of these use cases, clients and any other key stakeholders could have access to the data to provide as much transparency as possible and to quickly answer and provide documentation to key questions (related to program, health plan, or provider performance) from stakeholders with its export functionalities and data visualization.

Now you can have the tools you need to truly understand your business. Your team will get a more efficient actuarial analysis process and a deeper understanding of the underlying insurance exposure so you can make more informed business decisions.

Ease of use

Startup time for most users is measured in hours, not weeks, thanks to Arius’ intuitive, user-configurable interface, and its extensive help in parameterizing even sophisticated models.

Flexibility

Arius conforms to the way your department works, not the other way around. Customize reports or exhibits based on what you need, and the system will manage them for you.

Track record

Arius’ heritage includes some of the industry’s leading reserving tools. It combines both proven reserving strategies as well as some of the latest actuarial thinking.

Speed & reliability

Arius sets the standard for speed and reliability. All deterministic calculations happen in real time, and simulations run hundreds of times faster than in spreadsheet models.

Expertise

Milliman consultants have extensive experience using Arius, so we can provide the support you need, from basic training to a complete redesign of your reserving process.

Return on investment

Arius provides the shortest possible time to value thanks to fast implementation, ease of learning, and informative reporting.