Rich Moyer | Principal & Chief Product Officer | Milliman MedInsight

Milliman MedInsight ranks among the healthcare industry’s most highly regarded platforms for data warehousing and healthcare analytics. Its deep data sources and wide-ranging data solutions have been adopted by payers, purchasers, providers, and other healthcare clients. Earlier this year MedInsight was recognized in the 2019 Best in KLAS: Software and Services report, winning the award for Payer Quality Analytics. KLAS, a research firm focused since 1996 on the healthcare information technology (IT) market, recognized MedInsight for its outstanding efforts to help healthcare organizations deliver high-value and high-quality patient care.

The MedInsight ecosystem contains numerous solutions and products for data warehousing and healthcare analytics. MedInsight Solutions is a webbased portal and data mart for accessing client healthcare data. The MedInsight Solutions provides business intelligence capabilities, such as data visualization features (standard reports, dashboards, and ad hoc query tools), as it enriches client data with proprietary MedInsight products, thirdparty groupers, and industry standard measures. The MedInsight Solutions supports over 66 methodologies as it creates analytic content for clients. Roughly, 30 of those methods are proprietary to Milliman.

MedInsight clients may differ by industry sector and individual requirements, but they are attracted to the platform for similar reasons. Its flexible and collaborative approach, combined with its growing array of state-of-the-art technology and software solutions, offer healthcare analytics tailored to each situation. Additional MedInsight products can be installed in a client’s computing environment as part of the platform or as on-premise products. They include individualized tools for specific business requirements.

We spoke with MedInsight Principal and Chief Product Officer, Rich Moyer, about what clients can expect from the MedInsight ecosystem as well as a look into future directions of data management and analytics, including big data, artificial intelligence (AI), machine learning, and more.

Let’s start with the basics of MedInsight. Which sectors of the healthcare industry are your data analy_cs services primarily aimed at? 

The MedInsight Provider Solutions is a cloud-based software-as-a-service designed to support many different healthcare industry segments, including payers, at-risk providers / accountable care organizations (ACOs), employer sponsored health plans, state agencies administering Medicaid, public employee benefit plans, all-payer claims databases, third-party administrators (TPAs), and more. Its offering for all of these organization types is unique and complete, with a well-rounded and well-informed view of the industry.

We typically get claims and eligibility data from these sources as well as other types of data, including clinical in some cases, which we combine with benchmark data as we run it through a series of modeling methodologies, based on each client’s individual needs. This enables clients to analyze the costs, quality, and efficiencies of their healthcare systems by their specific requirements. Clients send us data, we process it, and then the results can be accessed directly with customizable interfaces containing a series of dashboards as well as other visualizations and software that clients can use to build their own individualized data analytics, focused on cost savings, improved patient quality, and a healthy return on investment.

How do you meet the individual needs of such a wide range of clients? 

We do have a wide range of clients, and our outreach more and more is global. For example, we just signed a contract to work with Taiwan’s healthcare data. In addition to the MedInsight Solutions, which leverages Milliman’s highly regarded cost and utilization benchmarks, we also offer a line of on-premise products. They are part of the MedInsight Solutions but can also be purchased separately, so in effect a client can choose only what it needs and avoid cluttering up analyses with extraneous data. These on-premise products include the Health Waste Calculator for measuring and quantifying inefficiencies, MedInsight Benchmarks that enables a client to measure costs and utilization by benefits and to segment health populations into useful categories, and Guideline Analytics, which measures hospitalizations at a clinical level.

The GlobalRVUs product is especially useful for health plans, ACOs, and other at-risk organizations to measure provider efficiency. It weights all services by assigning them relative value units (RVUs), including physicians, hospitals, durable medical equipment (DME), lab, and prescription drugs. Existing systems are often limited in focus to a particular type of provider, such as physician or pharmacy, and may not allow users to aggregate unit costs across provider types. GlobalRVUs solves this disconnect with an RVU-based system that covers all healthcare services. GlobalRVUs also includes a repricing process that assigns Medicare resource-based relative value scale (RBRVS) physician RVUs to physician claims enabling the client to compare and contrast costs based on a percentage of Medicare as well.

A new Product, the MedInsight Hayes Grouper, offers a robust decision-making capability that analyzes emerging technologies, integrating the evidence-based measures of Hayes (the industry standard for evaluating emerging healthcare technologies and clinical innovations) with Milliman’s industry-leading claims analytics. This opens up unprecedented insights, allowing payers, providers, and purchasers to spend more wisely on technology, plan for future disruption, reduce clinical and financial risks, and allow provider profiling. Clients can measure and quantify the value of a new technology and compare it with the money that would be spent to acquire and implement it, which can be very helpful because sometimes new technology proves to be wasteful, or even harmful. The wide array of solutions, products, and services the MedInsight ecosystem offers enables each client to pick and choose only what it needs, while still taking advantage of the massive technical and data resources of MedInsight along with its efficiencies. What’s more, with our global outreach we’re starting to see innovation and new technologies from new sources that we can bring back into the MedInsight analytics platform.

What has MedInsight been doing to adapt to the ongoing explosion of developments in data management and analytics, such as big data, AI, or machine learning? 

These developments are actually making things easier. One way is in the simple fact that computer processing speeds keep improving all the time. That means more and more complex methodologies and modeling can now be implemented and used. Data can be analyzed in much more detailed ways and can be processed much more quickly. While these advances in sheer processing power have had a huge impact on healthcare analytics, the areas of technology that currently get all the headlines and attention are AI, machine learning, and their related developments. A lot of the big data methods we’ve seen used by Google, Amazon, and others in the consumer sphere are now starting to arrive in healthcare analytics.

MedInsight is responding in a couple of tactical ways. Within Milliman, there is abundant subject-matter expertise in these areas and we often reach out to these experts to capitalize on that. At the same time, we are also establishing partnerships outside of Milliman, such as with MCG Health (part of Hearst Corporation), Value Based Insurance Design (VBID) Health, and Hayes. We are actively using and adapting the technologies they’ve developed and worked on, extending them toward the needs of our clients. We’ve released machine learning modules, for example, that provides deeper insight into trends that might normally be missed, such as network leakage, claims auditing or risk score optimization.

Many organizations with expertise and marketplace connections are contributing continually and in key ways to developments of data management and analytics. The MedInsight ecosystem, with all its assets and resources of healthcare claims data, follows closely all the new potential ways to look at data and analyze it. In fact, as we are keenly aware, many of these developments are happening within Milliman. We are constantly leveraging the latest technology enabling us to serve more clients in ways that are more sensitive to each one’s individual needs.

Can you give an example of MedInsight’s ability to adapt to developments in technology and the industry?

One of our most important client segments is the ACO, or accountable care organization. An ACO is an association of providers that collectively, in healthcare, tends to be in the best position to manage health populations and implement the efficiencies that can lead to systemic cost savings and improved outcomes. For example, looking at diabetics as a class and making sure they get all their screenings on time in order to head off the high costs of potential later developments. Or putting more universal treatments such as vaccines into more cost-effective places where they are more likely to be utilized. Providers have the best ability to improve the quality and the experience of care processes.

ACOs have become a significant factor in healthcare in the past 10 years and a large market for the MedInsight ecosystem. We currently serve and work with over 100 ACOs, including many of the most prestigious and innovative providers in the country, including Cleveland Clinic, Scripps, and others. Many large organizations working to improve patient care are using the MedInsight Provider Solutions.

Our capacity to integrate clinical data into the MedInsight ecosystem, is continuously evolving so that the richness of the data we have available, combined with machine learning techniques and AI, gives us an ever expanding base of opportunities to help improve care in much more detailed and actionable ways. We’re ideally suited to support ACOs in many ways. We have technology experts working across many different platforms, and we also have a large number of people at Milliman who really understand the detailed underpinnings of the healthcare market. On top of that, we continue to establish partnerships with other consultants who have even more expertise, working with them to create and build software applications and tools. This enables us to move at the speed of the industry, and even to stay ahead of it and lead.

Healthcare tends to evolve very slowly, but it can also move quickly and erratically by sector, with new technology appearing virtually overnight introducing new ways of doing things and looking at old problems. Our balance of internal expertise in the healthcare market, the developing technology pieces, and consulting partnerships with even more robust solutions enables us to move quickly and adapt.

What can you tell us about MedInsight’s work with electronic medical records (EMR) technology?

In the last year we have been focusing on doing more with clinical data, in particular bringing together claims data with clinical data and making both of these rich data sources work together to offer a more complete picture of what’s going on in healthcare. This helps our clients take advantage of all their data assets. For EMR data specifically, we have again been working with some external partners. One is focused on clinical data integration—ways to collect EMR data, warehouse it, and then send it back to individual EMRs when it is needed. This helps clinicians get a fuller picture of a patient in real- time.

At the same time we’ve been building the analytics within the MedInsight ecosystem to make claims and other sources of data (such as demographics and social determinants of health) available to combine with clinical data. For the backend of that effort we’ve partnered with a vendor whose systems can take data from the MedInsight Provider Solutions, such as risk scores and quality measures, and transmit it in real-time to the EMR. That means a clinician can see, for example, that a patient may have a diabetes diagnosis but they have not provided blood draws within the necessary time spans. This would enable the clinician to order a blood test on the spot for the patient, knowing it was medically necessary. That’s an example of how we’re trying to integrate claims data and clinical data, working with partners who have specific areas of expertise, to better serve all of our clients.

About the Leader 

Rich Moyer has been designing and implementing data warehouse and analytic solutions for over 30 years. As Milliman MedInsight’s Principal and Chief Product Officer, he has been responsible for product strategy, marketing, and implementation of quality management. Rich previously was the director of decision support and data warehousing for Group Health Cooperative in Seattle and Kaiser Permanente Northwest in Portland, Oregon. While at both organizations, he implemented new data warehouse and decision support applications. Additionally, he managed the development of rating/underwriting, HEDIS, cost accounting/management, disease management, and provider contracting analytic applications.

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