Milliman MedInsight Benchmarks

Milliman
MedInsight

Millimans MedInsight Benchmarks is a healthcare

analytic tool that provides the ability to create a customized
benchmark specific to any particular segment of a clients
population(s). Combining Milliman Health Cost Guidelines
(HCGs) methods and the companys years of benchmark
experience, the MedInsight team has created a tool with a
core of vast empirical data, intimate local market knowledge
for adjustment factors, and a wide number of plan and
provider agreement variables.
Background: Comparative Healthcare
Data in the Marketplace

The combination of looming healthcare reform

and trying economic times is driving healthcare
organizations to find new ways to manage their
financial and clinical performance. A crucial piece
of every strategy is the use of benchmarks for
setting goals and communicating objectives to
a wide range of stakeholders. Often, healthcare
organizations perform one-time benchmark
studies using external bodies and their static
benchmarks. This use of external data is no longer
adequate for todays fiercely competitive and
rapidly evolving marketplace.
Common issues with the use of external
benchmarks include:
Benchmarks that are based on limited
sample sizes
Aggregated empirical data that is devoid of local
market adjustments and is unable to provide a
realistic picture of the marketplace
Lack of drill-down capabilities that would
facilitate a greater depth of understanding
High total cost of ownership: Impractical
benchmarking methods that require significant
data integration efforts in addition to in-depth
analytic review
Difficulty tracking external benchmarks over time

MedInsight Benchmarks Highlights

MedInsight Benchmarks provides analysis of

the population in various views starting with a
benefit service package perspective based on
the Milliman HCG industry standard. The tool
supports numerous means to aggregate and drill
into data sets as its core capability produces
benchmarks by procedure codes, revenue codes,
diagnostic-related groups (DRGs), drug names,
therapeutic classes, diseases, and other publicly
available analytic methodologies.
MedInsight Benchmarks supports analysis by most
any dimension a client may need for standard or
ad hoc reporting. Typical reports are by line of
business (commercial, Medicare (risk or fee-forservice) and certain Medicaid benefits); by product
(EPO, PPO, and HMO); by segment (including
commercial small and large group, individual); and
geographic region.
The tools personalized benchmarks enable an
understanding of utilization and cost variance by
HCG category through the identification of under,
over, and inappropriate usage patterns. With
the cost and utilization data organized, grouped,
and benchmarked, your organization can better
evaluate what is driving costs,utilization and
trends within your populations.
MedInsight Benchmarks is designed to be
integrated with core systems, e.g., monthly
reporting, or accessed as a standalone web
application, e.g., ad hoc reporting for immediate
benchmarking needs.
It is a powerful analytic dimension that
can be updated monthly to enrich all data
warehouse environments.

Milliman
MedInsight

Benefits of MedInsight Benchmarks

The MedInsight Benchmarks application

offers the ability to generate custom-tailored
benchmarks with deep drill-downs of insight
for most all commercial, Medicare and
Medicaid populations, geographic regions
(all U.S. states and territories), and benefit
plan(s). The vast Milliman empirical database,
rigorous organizational methods, and advanced
adjustment factors let you effectively use your
data for:

The Milliman research team applies the highest

standards of data integrity to the empirical data
in order to create advanced adjustment factors
such as the following:
Geography and industry
Age/gender
Benefit design
Group size: Individual, small and large groups

Medical loss ratio analysismeasure cost and

rating development. Also benchmark most any
type of provider reimbursement model to identify
suboptimal contracting situations.
Healthcare reform and benefit modeling
the tool can account for thousands of benefit
combinations adjusting utilization down to the
service and patient level.
Performance and trend managementmonthly
trend factors co-mingled with population
adjusted benchmarks permit review of any
segment or cohort across any period of time.
Care and quality managementleverage
condition-based metrics to bolster target goals
for disease management programs. Incorporate
benchmarks into your prospective review of
inpatient and outpatient hospitalizations.

Chronic diseases: Diabetes, asthma, acute

low back pain, cardiovascular conditions,
uncomplicated hypertension, chronic obstructive
pulmonary disease
Selected procedures such as coronary
angioplasty (PTCA), coronary artery bypass graft
(CABG), and prostatectomy
Customization functionality that leverages
the Milliman empirical database to create
personalized adjustment factors
Benchmarks are created as a range of the degree
of medical management by service, expressed
from little to no medical management (loosely) to
the most advanced managed care models (well).
Even create your own target benchmarks since
your medical management levels might be some
where in between.

Create custom methodscombine your

proprietary methods with Millimans advanced
local market-adjustment factors and vast
normative data set.
MedInsight Benchmark Methodology

The Milliman Benchmark database is one of the

healthcare industrys largest normative data sets
in the country, and includes contributors such
as national payers, large employers, and the
Centers for Medicare and Medicaid Services 5%
data sample. The empirical database contains
more than 35 million lives and 2 billion records
of medical claims, pharmaceutical claims, and
eligibility information. We employ rigorous data
collection methods along with our adjustment
factor process to create the most credible
database for benchmarking.

The MedInsight Benchmarks: Just upload your plan

design and your enrollment demographics and it
will generate a benchmark report in minutes. There
is no need to provide Milliman with a large claims
file in order to have the benchmark report produced.
This tool is self-sufficient.

Millimans Health Cost Guidelines and the services

offered by the MedInsight practice can help identify key
healthcare utilization metrics that differ from accepted
benchmarks. These insights help clients reduce their
healthcare costs and reach their goals of improving care
quality and efficiency.
If you are seeking to add value to your healthcare
services while containing costs, contact us to learn more
about the MedInsight Benchmarks and the wealth of
expertise, data management, and analytic technology
that Milliman offers. We can help you be successful and
would be happy to meet with your team to discuss your
needs and our capabilities.

Milliman is among the worlds largest

independent actuarial and consulting
firms. Founded in Seattle in 1947 as
Milliman & Robertson, the company
currently has 54 offices in key locations
worldwide. Milliman employs more than
2,400 people. The firm has consulting
practices in healthcare, employee
benefits, property & casualty insurance,
life insurance and financial services.
Milliman serves the full spectrum of
business, financial, government, union,
education and nonprofit organizations.
For further information, visit milliman.com.

For more information on Milliman

MedInsight services for community
health exchanges, please contact:
Todd Fessler
Sales and Marketing Director
+1 248 656 2940
todd.fessler@milliman.com
medinsight.milliman.com