eVBRSync™ is a comprehensive value-based payment reconciliation platform to capture accurate value-based reimbursements efficiently

Streamline value-based reimbursement initiatives with eVBRSync™, explicitly designed to automate the reconciliation process and help Healthcare Payers, TPAs, and ASOs to gain control of data and determine which structures are effective.

Industry Challenge

  • Managing reimbursement details in spreadsheets
  • Exchanging payment structures over emails

Impact

  • Version control issues
  • Reconciliation data inaccuracies.

Our Solution

  • Creates a single source of truth for FFV payments data including non-bundled payments and value-based reimbursement contracts
  • Improves FFV payment accuracy, transparency, compliance, and timeliness

Industry Challenge

  • Multiple hand-offs of reconciliation and reimbursement data between finance, billing, and other teams
  • Manual review and approval processes

Impact

  • Data inaccuracies
  • Misinterpretations
  • Process inefficiencies

Our Solution

  • Out-of-the-box workflow automation solution
  • Streamlines and automates the reconciliation process
  • Improves communication among stakeholders
  • Boosts process efficiencies

Industry Challenge

  • Manually generating of FFV payments
  • Manually tracking and updating FFV payments

Impact

  • Incorrect payments
  • Increased financial risks
  • Negative impact on provider relationships

Our Solution

  • Empowers Payers, TPAs, and ASOs to auto-generate FFV payments
  • Improves provider experience and regulatory compliance
  • Generates payments including pay-for-performance, shared risk/savings, partial cap, full cap, global payments, incentive/PCMH/care coordination, and bundled

Industry Challenge

  • Lack of a scalable solution
  • Dependency on point solutions
  • Evolving business needs
  • Dynamic market
  • Constantly changing compliance requirements

Impact

  • Operational inefficiencies
  • Decreased business growth

Our Solution

  • Modular and scalable solution
  • Out-of-the-box solution
  • Quick and easy implementation
  • Scalable to support business growth

Why eVBRSync ?

Drive cost and quality improvements, empower value-based strategies, improve Provider relations, and comply with FFV reimbursements with data-driven and technology-enabled automated solution.
Retroactive Transactions
100%
Speed to Market
70%
Errors
90%
Processing Time
80%

Choose an end-to-end solution or select modules to solve specific pain points

Our value-based payment reconciliation solution can be molded according to your business. Select from our integrated modules that suit your business to address pain points and maximize investments.

Integration of other solutions in eVBRSync™ ecosystem

eClaimsEngine™ – Our claims configuration solution, integrates as a component of eVBRSync™ to configure your FFV programs at one place with intelligent decision support, eliminate repetitive data entry into Core-Admin and other systems, keep your claims system up to date, and automate the maintenance of your product configuration.

Listen to Our Customers

''The value-based reimbursement system that was developed was not only functionally robust from an online perspective, but it also reduced batch processing windows from 18–24 hours to 4–6 hours. The amount of information that an end-user could view 'at-a-glance' greatly enhanced productivity. The sophisticated drill-down features helped streamline the plan's operational activities.''
— VBR Program Manager
''We had exceptionally aggressive timelines to deliver and deploy a very complex payment reimbursement system. Simplify Healthcare met the deadlines, even as our customers continued to add requirements while we were in trial testing. Their team worked many nights and weekends to enable our Plan to go live on time.''
— VBR Project Manager
''Simplify Healthcare's Advance Payment Platform (eVBRSync™) is a value-based payment reimbursement system. It combines the payer's analytics capability with a powerful reimbursement engine that complements existing claims-based FFS payments. eVBRSync™ is a modular solution that can be implemented in a phased manner per payer readiness. It is suitable for all lines of business, including commercial and government programs.''
— IDC Research Analyst

Frequently Asked Questions (FAQs)

Here are the answers to the most frequently asked questions about implementing end-to-end value-based payment reconciliation solution and partnering with Simplify Healthcare.

1. What is Automated Value-Based Payment Reconciliation solution (eVBRSync™)?

Automated value-based payment reconciliation solution (eVBRSync™) solution enables Health Plans, TPAs, and ASOs to automate value-based payment reconciliation. It combines existing analytics capability with a powerful reimbursement engine that complements existing claims-based payments. eVBRSync™ allows Payers, TPAs, and ASOs to house all non-bundled fee-for-value payments within one solution, dynamically matching provider contract provisions with provider performance data to determine accurate risk-adjusted payments, and ensure compliance with FFV reimbursements.

2. What is value-based payment reconciliation?

Traditional fee-for-service (FFS) reimbursement contributes to the high cost of care that plagues the healthcare system today. FFS reimbursement rewards Providers for delivering services and fails to differentiate payments based on quality and value. Value-based reimbursement is designed to shift the basis of reimbursement from volume to value by incorporating incentives to improve financial and operational performance.

Payers, providers, and governments have embarked on a journey to transform the healthcare payment system from one that rewards volume to rewards quality and value. Under the value-based payment (VBP) programs, Payers, TPAs, and ASOs reward providers for reducing healthcare costs while maintaining or improving quality.

3. What are the challenges with manual payment processes?

Manual processes have a lot of issues that can be eliminated with an automated solution. Here are some of the biggest challenges with manual payment processing:

  • The Core-Admin system may not be able to handle value-based payment reimbursements efficiently.
  • Complex and manual value-based reconciliation processes and Excel spreadsheets are time-consuming and error-prone.
  • Lack of efficient processes to scale and grow value-based reimbursement arrangements.
  • The significant lag between provider actions and incentive payments reduces the effectiveness of the value-based incentives.

4. How does value-based payment reconciliation platform (eVBRSync™) help Payers, TPAs, and ASOs?

The advanced value-based payment reconciliation (eVBRSync™) is an intelligent value-based reconciliation system to reduce payment and data entry errors, batch processing timelines from an average of 18 – 24 hours to 4 – 6 hours. Here are some of the key features of the eVBRSync™ platform:

  • Capture all of the attributes and rules of each FFV contract in a single source of truth.
  • Automate the reconciliation process, with workflow capability for review and manual approval.
  • Increase the frequency, timeliness, and transparency of payments and associated incentive data to providers.
  • Scale operations and achieve value-based payment reimbursements quality and financial goals.
  • Gain visibility across all segments and ensure FFV reimbursements with regulatory agencies and external auditors’ robust audit trails.
  • Improve provider relations with clarity on policies, transparency in payments, and prompt payments.

5. What are the benefits of automating your payment processes?

Healthcare payers and TPAs can now consolidate all the non-bundled FFV payment programs in a single automated solution. You would be able to integrate via ETL seamlessly, Web API, or Batch files to/from various sources and streamline payment processes. An automated claims payment processing platform like eVBRSync™ helps incentivize the providers, build better relations to encourage providers to offer better services to the members, gain transparency of data for the key stakeholders, and provide accurate payment outcome information. With effective automation, Payers, TPAs, and ASOs can dramatically expand the number of FFV contracts to realize value-based payments’ true benefits.

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Simplify Healthcare listed as a sample vendor in Gartner Hype Cycle for US Healthcare Payers 2018

Simplify Healthcare, a leading healthcare technology solutions company for Health Payers announced that the company has been identified as one of the few vendors in the Gartner 2018 Hype Cycle for Value-Based Payment Reconciliation Systems.

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