Price transparency, “pay for performance,” and report cards challenge hospitals and physicians to improve performance. Success in this new environment requires clinical, data, analytical, and financial sophistication, a demanding level of consulting that Milliman’s professionals deliver. We are experts on payer economics and evidence-based medicine; our professionals bring insight from today’s trends as well as understanding of the successes and failures of the managed-care wars.

Managing the risk of payer contracts

Contracts are often now so complex that it is difficult for hospitals to understand trends in income or the risks they face. Forecasting income in this environment is among the most difficult analytical tasks in healthcare. Short-cut analyses and rules of thumb that worked in the past can be a recipe for financial losses, which is why Milliman’s actuarial tools, experience, and managed-care expertise are so valuable.

Strategic hospital-physician programs

Today’s hospitals are seeking ways through which physicians can be rewarded for activities that benefit the hospital. While physician hospital organizations are largely institutions of the past, the need for hospitals and physicians to work together has never been more important.

Milliman consultants helped one large medical center by developing a multitiered strategy that included a joint physician-hospital medical malpractice program, common electronic medical records (including the physician offices), a common benefit platform, and pay-for-performance. The hospital succeeded in passing requirements set by its legal team and is now solidifying its physician base, one practice at a time.

Case management can optimize income

Milliman’s on-site work helped one hospital eliminate more than $6 million in annual payment denials. We helped the hospital implement a case management program that identified and corrected delays in patient diagnosis, treatment, and discharge, and improved chart documentation.