Value-based care consulting services
From strategy and readiness to analytics and contract operations, we support providers and payers across the full value-based care (VBC) lifecycle.
Supporting the transition to value-based healthcare in the UK
Healthcare systems are increasingly shifting from fee-for-service (FFS) models to value-based care (VBC) contracts, where reimbursement is linked to patient outcomes, quality, and efficiency. This transition presents both opportunities and challenges for healthcare providers, insurers, and investors.
Our VBC consulting services support organisations across the UK in designing, implementing, and optimising value-based healthcare strategies. We combine actuarial expertise, health economics, and advanced analytics to help clients improve outcomes and sustain performance across the enterprise while managing financial risk and cost pressures.
A data-driven approach to value-based care
Successfully implementing value-based care (VBC) requires a robust understanding of clinical outcomes, cost structures, and risk dynamics. Our team brings significant experience in developing sustainable value-based healthcare models aligned with organisational objectives and regulatory requirements across multiple jurisdictions.
We support insurers in moving from concept to execution by combining actuarial modelling, healthcare data analytics, and strategic insight. This enables the design and implementation of practical, outcomes-based contracts that improve patient outcomes while managing financial risk.
How we help
Value-based care strategy & capability gap assessment
We work with healthcare insurers and providers to assess the strategic and operational readiness of value-based healthcare models, tailoring our approach to specific markets and organisational contexts. Our value-based care (VBC) consulting services are designed to support successful implementation and long-term sustainability that is in alignment with UK healthcare system requirements.
Morbidity & risk adjustment design
We design and quantify morbidity-based risk adjustment mechanisms for value-based care (VBC) contracts, ensuring that differences in patient risk profiles are appropriately reflected. Our approaches are transparent, defensible, and practical for both payers and providers, supporting fair and sustainable risk-sharing arrangements.
Population attribution & capitation sizing
We define and estimate attributed populations for capitation and other value-based care (VBC) models, ensuring that population definitions are robust, transparent, and aligned with contractual and operational requirements. We apply practical approaches to population attribution, market share assessment, and capitation rate setting to support sustainable reimbursement structures.
Risk mitigation & contract mechanics
We design risk mitigation frameworks and contract structures to manage exposure to high-cost and high-frequency events within value-based care (VBC) arrangements. Our solutions include reinsurance, risk pooling, and risk corridors, tailored to support sustainable and balanced risk-sharing between payers and providers.
We ensure that contract structures are transparent, operationally practical, and aligned with regulatory and organisational requirements.
Contract prototypes and scenario testing
We develop prototype financial models to compare alternative contract structures, stress test key assumptions, and quantify risk-reward trade-offs under a range of scenarios. Our approach combines actuarial modelling, healthcare data analytics, and scenario analysis to support informed decision-making and robust contract design.
Value-based care strategy and capability gap assessment
We assess your value-based care (VBC) strategy and operating readiness across people, processes, and analytics, ensuring alignment with organisational objectives and market requirements. We identify capability gaps and provide practical, prioritised recommendations to support successful implementation and execution.
See how Milliman is helping clients
Risk-sharing model design for the National Health Service and a private provider
Challenge
The National Health Service (NHS) and a private care integrator were exploring a shared savings arrangement but required a robust framework to define population eligibility, measure savings, and ensure fair risk-sharing. Key challenges included incorporating risk adjustment, aligning incentives with outcomes, and ensuring the model was operationally practical.
Approach
We applied actuarial and healthcare analytics expertise to design and review the proposed value-based care (VBC) model. This included assessing population attribution and eligibility criteria, evaluating risk adjustment methodologies, and defining savings measurement approaches against appropriate benchmarks. We also considered how outcomes-based metrics could be integrated into the contract structure.
Outcome
We developed a transparent, risk-adjusted shared savings framework that balanced financial risk and reward for both parties. The resulting model provided clear governance, measurable performance metrics, and a practical foundation for implementation within a VBC environment.
Contact us to find out more.
We’re here to help
If you are exploring value-based care (VBC) or looking to implement a value-based healthcare strategy, our team can help you navigate the transition with confidence. Contact us to discuss how our actuarial and analytics expertise can support your organisation.
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We’re here to help you break through complex challenges and achieve next-level success.