Milliman's interactive tool under the Qualified Entity Program of the Centers for Medicare and Medicaid Services (CMS) allows users to explore how healthcare system performance is associated with regional social determinants of health (SDoH) characteristics such as socioeconomic status and healthcare provider supply, after accounting for the differences in underlying disease burden that are expected to impact performance.
As a certified QE for all 50 states and the District of Columbia, Milliman has a combined claims dataset of over 50 million Medicare fee-for-service (FFS) beneficiaries and over 100 million commercially insured members.1 Milliman's 2025 QE Report includes results on the combined data for quality measures following hospital-based acute care for 2018 through 2022.
Services following hospital discharge are major contributors to overall healthcare costs. Performance below benchmarks on these measures may reflect shortcomings in the provision of high-quality care during the acute care encounter, the follow-up period post-discharge, or more generally, in ongoing health management over time in the community. Understanding variation in provider quality performance in different geographic areas highlights potential gaps in care that may represent opportunities to improve quality and reduce healthcare costs.
The interactive tool provides users with information to help understand healthcare system performance for people who live in a geographic area. The interactive tool presents two primary map-based views:
- Metrics by Geography: This view allows users to view results on a map of the United States for a single metric—either an SDoH characteristic or a quality measure result.
- Geographic Comparison: This view allows users to compare SDoH characteristics and quality measure results between a collection of small geographic areas in one U.S. census division and a collection of small areas in another census division. Users may choose a range of values for select SDoH characteristics, and the map and summaries update to reflect the collection of small areas that meet those criteria.
For additional detail on the methodology and external data sources used to populate the interactive tool, download the Detailed Methodology.2 For additional detail on how to use the interactive tool, download the Report User Guide.
For the best user experience, please access the interactive tool via Chrome on desktop.
Caveats and limitations
Milliman's interactive tool was developed to advance health equity by allowing users to explore variations in healthcare system performance measured using claims data in the context of the SDoH characteristics of a geographic area. As explained further in the Detailed Methodology and Report User Guide, the SDoH characteristics of a geographic area that are displayed in the interactive tool reflect average levels across a geographic area based on a variety of data sources; they do not directly represent specific individuals included in the combined claims data.
All information displayed in the interactive tool, including the MHDRI, was developed for geographic areas and should not be used to draw conclusions regarding individual member risk or characteristics.
Any interpretation, conclusion, and/or opinion reached based on the information displayed in the interactive tool does not constitute the findings, policies, or recommendations of Milliman.
The American Academy of Actuaries requires its members to identify their credentials in their work product. Harsha Mirchandani and Julia Weber are members of the American Academy of Actuaries and meet its relevant qualification requirements.
For a comprehensive list of limitations, refer to the 'Caveats and limitations' section in both the Detailed Methodology and Report User Guide.
1 Centers for Medicare and Medicaid Services. (2025, January 14). Qualified Entity Program. Retrieved May 30, 2025, from https://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/QEMedicareData.
2 Social Deprivation Index (SDI) data was used with permission from the American Academy of Family Physicians.