Navigating the Current Economic Challenges: The Role of Revenue Cycle Management

By Jessica Lockhart, Vice President of Engagement & Analytics Solutions


As the healthcare industry faces unprecedented economic challenges, we are starting to see payers become even more laser-focused on evaluating and implementing efficient revenue cycle management strategies. In this article, we will explore four key trends in revenue cycle management and show you how VBA’s integrated suite of solutions can support you along the way.


Efficient Claims Processing: A Core Focus

In today’s economic climate, payers are increasingly 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 also strengthens payer-provider relationships and member trust. Using VBASoftware, payers can leverage these features for more efficient claims processing:

  • 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 – The VBAdjudicate claims processing engine 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 – Coming in late 2024, VBA will release our new VBAssist product which will empower you to administer your business more efficiently. It will include an integrated AI learning model that can provide claims administration recommendations and insights in real-time.


Plan Design: A Foundation for Success

Because plan designs play 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 employees flexible benefit options 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 is able to support a variety of plan designs and claim types including medical, dental, vision, HRA/HSA benefits, flex plans, life policies and disability benefits.


Primary Care and Value-Based Care Models: Driving Change in Behaviors

Managed care is back. After years of creating plan designs that enabled members to manage their own care through 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.

VBAnalytics provides 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 us to schedule a consultation and a live demo of VBAnalytics. We can show you how to get the most out of your population health and value-based care reports.


Financial Reporting: Informed Decision-Making

The last area we will highlight is accurate and timely financial reporting to assess performance. According to Gartner, in 2024 healthcare payers will continue to invest in and leverage robust reporting and analytics tools to gain insights into revenue, costs and profitability and identify 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.

VBAnalytics can help you to form a more complete financial picture, including:

  • 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

All of this information is available with just a few clicks. If you would like to learn how you can get a more complete financial view using VBAnalytics, contact us for a consultation.


Final Thoughts

In summary, in the current economic environment, payers understand that they must prioritize revenue cycle management and focus on key areas such as plan design, primary care and value-based care models, efficient claims administration, population health management and financial reporting. By embracing these critical components and leveraging VBA’s suite of solutions, payers are able to navigate the changing landscape, foster financial stability, improve member outcomes and position themselves as leaders in the evolving healthcare industry.

Contact us to set up a consultation with one of our experts.