In today’s economic climate, payers are recognizing the importance of effective administration of claims to ensure accurate reimbursement and minimize friction with providers. As AI and machine learning continue to be at the forefront of the conversation, we see payers exploring additional ways to automate manual workflows and leverage artificial intelligence and machine learning to expedite claims processing, reduce errors and enhance provider satisfaction. Efficient claims administration not only improves the overall revenue cycle, but it also strengthens payer-provider relationships and member trust.

Using VBASoftware, clients can leverage these features for more efficient claims processing through:

• Process Automation - Create automated responses to an event within VBASoftware. This can include auto-generation of emails, letters or reports or sending letters, reports, invoices and other information to a VBAGateway portal.
• Serverless Computing (VBAdjudicate) - All VBA clients have been migrated to the VBAdjudicate claims processing engine, which expedites the loading of incoming EDI claims from providers and allows you to process tens of thousands of claims in minutes to support prompt payment initiatives.
• Generative AI (VBAssist) - Coming in 2024, VBA will release our new VBAssist product, which will empower clients to administer their businesses more efficiently. It will include an integrated AI learning model that can provide claims administration recommendations and insights in real time.

Because plan design plays a critical role in attracting and retaining members and managing costs, we are also seeing a trend in implementing plan designs that strike a balance between affordability and comprehensive coverage (i.e. $0 copay and $0 deductible plans for preventive care). Employers understand the benefits of offering flexible benefit options to employees that incorporate preventive care measures and promote wellness initiatives, and payers can use these plan offerings to foster healthier populations and minimize long-term healthcare costs.

VBASoftware can support a variety of plan designs and claim types including medical, dental, vision, HRA/HSA benefits, flex plans, life policies and disability benefits. If you have a plan design and you are not sure how to implement it in VBASoftware, contact VBA and we can provide your team with guidance on the best approach to obtain your desired outcome.

Managed care is back! After years of creating plan designs that enabled members to manage their own care though PPO models, payers are now increasingly recognizing the significance of primary care and value-based care models in improving patient outcomes and controlling costs. By incentivizing primary care providers and fostering collaborative relationships, payers can steer members toward providers who can help them manage their chronic conditions and reduce the likelihood of costly hospitalizations.

Value-based care models are here to stay as they help align incentives with quality outcomes, ensuring that payers deliver effective and efficient care. VBAnalytics with value-based care reporting helps support value-based care initiatives by providing comprehensive insight into member utilization, the prevalence of common chronic conditions and expenditures related to these conditions, along with insight into the efficiency of the delivery of care in your networks.

If you are looking for greater insight into:

• How efficiently providers in your network are delivering care to members
• How you can leverage data analytics to identify high-risk and rising-risk members
• Where you should target your interventions to promote healthier behaviors

Contact your dedicated VBA Account Executive for assistance with getting the most out of your VBAnalytics reports.

The last area we will highlight is accurate and timely financial reporting to assess performance. According to Gartner, healthcare payers will continue to invest in and leverage robust reporting and analytics tools in 2024 to gain insights into revenue, costs, profitability and identifying trends so they can make informed, strategic decisions. Payers need up-to-date information so they can adapt quickly to market dynamics and allocate resources effectively.
 
Clients are using VBAnalytics to form a more complete financial picture. Leveraging the utilization story along with the ad-hoc report workspace, clients have access to:

• Claims trends
• Premiums and administrative fees applied to claim spend
• A comprehensive view of reinsurance contracts
• Insight into distribution of payments to vendors/accounts payable
• A simple view of a plan’s medical loss ratio