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Gartner Research Note: How U.S. Healthcare Payers Can Optimize Costs by Choosing the Best Core Administration Vendors

Get your Gartner Research Note – How U.S. Healthcare Payers Can Optimize Costs by Choosing the Best Core Administration Vendors today: click here to download your guide.

Inside your How U.S. Healthcare Payers Can Optimize Costs by Choosing the Best Core Administration Vendors you will find market information regarding Core Administration Vendors. This guide will help your team as you decide on a benefits administration system.

Disclaimer for Report:
Gartner. How U.S. Healthcare Payers Can Optimize Costs by Choosing the Best Core Administration Vendors, Bryan Cole, 6 October 2017
Gartner does not endorse any vendor, product or service depicted in its research publications, and does not advise technology users to select only those vendors with the highest ratings or other designation. Gartner research publications consist of the opinions of Gartner’s research organization and should not be construed as statements of fact. Gartner disclaims all warranties, expressed or implied, with respect to this research, including any warranties of merchantability or fitness for a particular purpose. GARTNER is a registered trademark and service mark of Gartner, Inc. and/or its affiliates in the U.S. and internationally, and is used herein with permission. All rights reserved.

Virtual Benefits Administrator and Context4 Healthcare, Inc. Announce Real-Time Medicare Pricing Automation Capability

Real-time pricing during claim adjudication allows payors to become more powerful in the Real-time Health System

NAPERVILLE, IL, (September 18, 2017) – Virtual Benefits Administrator and Context4 Healthcare, Inc. are pleased to announce the release of real-time Medicare + UCR pricing. This latest addition expands VBA’s process automation in Real-Time Claims Payment (RTCP).

Available to VBA clients today, this solution provides real-time Medicare prospective payment system (PPS) pricing during claims processing. Direct PPS pricing ensures compliance with the Centers for Medicare and Medicaid Services (CMS). It eliminates complexity and the need to utilize less accurate substitutes like RBRVS.

The real-time Medicare pricing feature eliminates wasteful, manual processes that drive cost and human error. Automated NPI to CCN reconciliation significantly simplifies institutional pricing. Built in PPS intelligence automatically chooses which of the 16 PPS best fits each and every line in a claim without human intervention.

The Medicare solution also integrates Context4 Healthcare’s industry-leading Usual, Customary & Reasonable (UCR) fee data. This ensures VBA clients have Medicare gap fill pricing for the ~800 procedures not priced by CMS. This comprehensive solution is one of a kind in the health payer industry.

David Lung, VP at Context4 Healthcare, stated: “VBA is known for innovation in employee benefit administration. Medicare pricing is complex and time consuming. Context is proud to be a part of this advancement in automation and payer value.”

Tom Witter, President of Virtual Benefits Administrator, stated: “VBA is deeply committed to process automation that drives ROI. Real-time Medicare pricing expands our relationship beyond advanced claims editing with Context. It illustrates our agility in integrating best of breed features to maximize value for our customers.”

About VBA. Headquartered in Germantown, WI, VBA has over 20 years of experience in software development for health benefits administration. Our mission of providing Flexibility, Functionality, and Technology for our clients’ business solutions ensures they will optimize their daily business processes and deliver the highest level of customer satisfaction. www.vbasoftware.com. For more information, call (414) 946-1210.

About Context4 Healthcare, Inc. Headquartered in Naperville, IL, Context4 Healthcare has nearly 30 years of experience in software and data product development. Context is a leading provider of cloud based healthcare compliance and payment integrity solutions. These solutions serve hundreds of payer and provider clients, positively impacting millions of lives globally. www.context4.com.

VBA Included in 2017 Gartner Market Guide for Healthcare Payers Core Administrative Processing Systems

Get your 2017 Gartner Market Guide for Healthcare Payers Core Administrative Processing Systems today: click here to download your guide.

Inside your 2017 Gartner Market Guide for Healthcare Payers’ Core Administrative Processing Systems you will find recommendations and market information regarding the Healthcare Administration Software industry. This guide will help your team as you decide on a benefits administration system.

Disclaimer for Report:
Gartner, Inc., Market Guide for Healthcare Payers’ Core Administrative Processing Systems, Constance Sjoquist, 10 March 2017.
Gartner does not endorse any vendor, product or service depicted in its research publications, and does not advise technology users to select only those vendors with the highest ratings or other designation. Gartner research publications consist of the opinions of Gartner’s research organization and should not be construed as statements of fact. Gartner disclaims all warranties, expressed or implied, with respect to this research, including any warranties of merchantability or fitness for a particular purpose.

VBA New Client Update – Employee Benefit Systems

I am proud to announce that Employee Benefit Systems (EBS), which was established as a Third Party Administrator (TPA) in 1984 in Burlington Iowa, is now a member of the Virtual Benefits Administrator (VBA) family of clients.


Employee Benefit Systems (EBS), established as a Third Party Administrator (TPA) in 1984, prides itself on providing a full range of high-value insurance and administrative services to meet our customer’s needs.  EBS creates customized plans for your organization allowing for affordable benefits to your employees while controlling your costs and keeping your benefits running smoothly.

EBS has the capability to tap into the expertise and resources of our affiliated entities as needed to provide our customers with superior services at maximum value. EBS is a flexible, low-cost, high integrity, responsive firm eager to build a relationship with your organization while Helping Administer Your Success!

Because of the VBA Application’s features like process automation, hyperlink navigation, and offline auto-adjudication, EBS has gained a significant increase in efficiency!

They have also chosen the VBAGateway as their web portal. VBAGateway features the latest web technologies and architecture like SPA (Single Page Application), Responsive Design, Gamification, Intuitive Help, and POD (Personalized Object Data).

You can efficiently administer Life and Disability, Medical, Dental, FSA, HSA, HRA, COBRA, Vision and Medicaid/Medicare lines of business on one software system with VBA.

For more information on VBA and VBAGateway, visit our website at http://vbasoftware.com or call me directly at 262-946-1210 or send me an email at twitter@vbasoftware.com.

Sincerely,
Virtual Benefits Administrator
Thomas W. Witter
President

P.S. For more information about EBS, see their website at http://www.ebs-tpa.com

VBA Included in 2016 Gartner Market Guide for Healthcare Payers Core Administrative Processing Systems

Get your Gartner Market Guide for Healthcare Payers Core Administrative Processing Systems today: click here to download your guide.

Inside your Gartner Market Guide for Healthcare Payers’ Core Administrative Processing Systems you will find recommendations and market information regarding the Healthcare Administration Software industry. This guide will help your team as you decide on a benfits administration system.

Disclaimer for Report:
Gartner, Inc., Market Guide for Healthcare Payers’ Core Administrative Processing Systems, Constance Sjoquist, 18 June 2016.
Gartner does not endorse any vendor, product or service depicted in its research publications, and does not advise technology users to select only those vendors with the highest ratings or other designation. Gartner research publications consist of the opinions of Gartner’s research organization and should not be construed as statements of fact. Gartner disclaims all warranties, expressed or implied, with respect to this research, including any warranties of merchantability or fitness for a particular purpose.

Short-Term Savings are Paramount to Payers

Because of the artificially high turnover rates that exist in the current workforce environment created by our long-standing weak economy, self-insured Payers are not always interested or open to long-term ROI programs like Wellness and Disease Management. These have always been more difficult to sell based on ROI. The same is true for Medical Healthcare Plans, who are typically seeing a 20% to 25% turnover in their membership each year. The long-term efficiencies of these types of programs just are not what Payers are currently focused on.

SHORT-TERM SAVINGS ARE KING.

Technology products and services providing measurable, short-term savings in the next twelve to eighteen months are at the top of most Payers’ lists. Things like telemedicine, mobile apps for everything from diagnostics to benefit services, real-time web portal services for online administrative functions, and the process automation of administrative services all translate into short-term savings on both the provider services and administrative services side of the healthcare process.

BOTH SIDES OF THE AISLE ARE IMPORTANT

On the Provider side, reducing time in the hospital through improved surgical outcomes, expediting diagnosis, and effectively managing certain chronic illness at home through remote patient monitoring all contribute to reducing the cost of healthcare. Connecting health technologies to improve patient compliance and reduce office visits all combine to provide an attractive ROI in the short-term.

On the Payer or administrative side, comprehensive software systems, which streamline the eligibility and claim payment process flow through flexibility and automation, will eliminate redundancy and the expense of needing multiple, more singularly-focused functionality platforms. This contributes significantly to the reduction of variable overhead costs and the risk of errors related to duplication of effort and unnecessary data integration.

RESISTANCE TO CHANGE

Unfortunately, the reluctance to change and to embrace new technology results in the desire to maintain the status quo, which by today’s standards, is unacceptable. As with all technological advances like the internet, there will continue to be an acceleration, which you need to be a part of if you want to remain relevant.

VBA Software March Madness Bracket Winners Announced

VBA Software March Madness had 25 participants in its first March Madness NCAA Bracket Challenge open to clients and outside contacts. The tournament had an number of upsets, as you would expect. It was truly exciting and the final result wasn’t reached until the final second of the Wisconsin-Kentucky game when Traevon Jackson’s shot for Wisconsin bounced out. No one picked the ultimate champion UCONN, which beat Kentucky in the championship game.

WINNERS – Each will receive a basket of delicious Wisconsin Cheese

  1. Jay Mason – Elli Health, AVIA Health Innovation, My Health Direct, Inc. – 89 points
  2. Brian Cox – JW Terrill – 86 points
  3. Tom Witter – VBA – 80 points

Champion Picks

  • Florida – 12
  • Michigan State- 6
  • Louisville – 2
  • Wichita State – 2
  • Arizona, Kansas, Wisconsin – 1

Thanks to all who participated. If you missed it, be sure to enter next year.

ICD-10 Deadline Delayed One Year

The U.S. Senate voted to delay the deadline for ICD-10 compliance again from October 1, 2014 to at least October 1, 2015. The cost of this delay is estimated be between $1 billion to $6.6 billion dollars according to CMS. Combined with the first delay from October 1, 2013 to October, 2014, that would mean that between $2 billion and $13 billion dollars have wasted in the past two years – in addition to the original billions of dollars for the initial ramp-up costs spent throughout the health care industry.

While the additional time to achieve compliance is beneficial to some organizations, it punishes others who have already invested the time and money to achieve compliance. New standards almost always require an investment in new and improved technology, which quickly becomes an “expected” commodity. While “necessity is the mother of invention”, until utilized, it is waste.

Hopefully, those who sit in judgment of the U.S. healthcare system’s cost-effectiveness are wise enough to understand that dollars spent on healthcare delivery is only a fraction of what is paid by the patients, or users, of the healthcare system. We can all use a deduction for our expenses in the calculation related to our performance.

A major step in the solution to improving healthcare delivery and reducing its cost is to adopt cost-effective technology, which will deliver comprehensive and functional capabilities in a timely manner.

Tom Witter

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