Connect all parts of the VBR program from contracts, claims, reimbursements, outcomes, and performance

Streamline value-based reimbursement initiatives with VBR1™, explicitly designed to improve the workflow, connectivity, and transparency of information between Payers and Providers to ensure successful management of risk arrangements.

Improve Negotiations and Development of Risk-Based Models

Evaluate VBR Options

Simplify VBR reimbursement modelling and evaluation with access to interactive tools.

Improve Negotiations and Development of Risk-Based Models

Evaluate VBR Options

Simplify VBR reimbursement modelling and evaluation with access to interactive tools.

Streamline Contracting Workflows

Manage VBR Contracts

End-to-end VBR Contract Management with the ability to generate, share, sign, and store contracts​.

Enhance Provider Experience and Regulatory Compliance

Simplify VBR Communication

Effective VBR communications through access to provider support staff, care management teams, and educational materials from a single platform.

Enhance Provider Experience and Regulatory Compliance

Simplify VBR Communication

Effective VBR communications through access to provider support staff, care management teams, and educational materials from a single platform.

Provide Transparent Access to Data

Enable VBR Transparency

Leverage an interactive portal to transfer medical records, access decision management tools, claims payments, and patient level quality analytics​.

Audit and Reconcile Care Outcomes and Payments With Risk Contract Provisions

Streamline VBR Audit and Reconciliation

Match provider contract provisions with outcome data over a performance period to assess pay-for-performance, shared savings, and alternative payment model success​.

Audit and Reconcile Care Outcomes and Payments With Risk Contract Provisions

Streamline VBR Audit and Reconciliation

Match provider contract provisions with outcome data over a performance period to assess pay-for-performance, shared savings, and alternative payment model success​.

Assess Overall Performance of Risk Programs

Simplify VBR Performance Assessment

Ensure connectivity to overall VBR performance statistics and population health outcomes​.

Facilitate VBR Payments

Calculate and generate risk, capitation, fee-for-value, and bonus payments based on VBR programs.

Highly Configurable, Modular, and Scalable Solution

An Out-of-the-Box Modular Solution

Ensures seamless and fast implementation, and scales with your business.

Highly Configurable, Modular, and Scalable Solution

An Out-of-the-Box Modular Solution

Ensures seamless and fast implementation, and scales with your business.

Listen to Our Customers

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.

What is Automated Value-Based Payment Reconciliation solution (VBR1™)?

Automated value-based payment reconciliation solution (VBR1™) 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. VBR1™ 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.

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.

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.

How does value-based payment reconciliation platform (VBR1™) help Payers, TPAs, and ASOs?

The advanced value-based payment reconciliation (VBR1™) 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 VBR1™ 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.

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 VBR1™ 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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