Health Plans and Payers Align Around VBRO Technology to Meet CMS Payment Reform Demands; Top-Rated Vendors Identified for Impactful Results
LAS VEGAS, NV / ACCESS Newswire / June 12, 2025 / In preparation for AHIP 2025, Black Book Research surveyed 849 health plan and managed care leaders nationwide to evaluate current technology priorities and strategic investments, with half indicating they are AHIP attendees this year. Results overwhelmingly indicate that Value-Based Reimbursement Optimization (VBRO) is now critical to organizational success under CMS and state payment reforms.
Health plans utilizing top-rated VBRO solutions report up to an 81% improvement in cost containment, risk adjustment accuracy, and outcomes-based financial performance, highlighting the urgency for payers to modernize reimbursement infrastructures amidst increased CMS scrutiny and evolving alternative payment model (APM) requirements.
20 Top-Rated Vendors Driving Value-Based Reimbursement Optimization for Health Plans
Alphabetically Ranked by Surveyed Payer and MCO Leaders, Black Book Research Q1-Q2 2025
Vendor |
Honored Payer-Centric VBRO Capabilities |
|---|---|
Arcadia |
Population health analytics enabling payer-driven quality tracking and member risk identification across VB programs. |
Carelon Digital Platforms |
Member engagement tools supporting Star Ratings, care-gap closure, and VB outcomes. |
Cedar Gate Technologies |
Bundled payment analytics for payers managing shared savings or downside risk. |
Cotiviti |
Comprehensive VB analytics, payment integrity, and quality monitoring aligned with Medicare Advantage incentives. |
FinThrive |
Real-time revenue insights, predictive VB payment modeling, and alignment with payer goals. |
FTI Consulting |
Strategic advisory for MCO transformation to outcome-based payment and member cost-value optimization. |
Gradient AI |
AI-driven underwriting and predictive tools for VB contract performance forecasting. |
HCL America |
Infrastructure integration supporting VB model administration and CMS compliance. |
HealthEdge |
VB administrative platform with automated contract management, claims integration, and provider reporting. |
Innovaccer |
AI-powered population health data platform providing payer-focused VB analytics and risk management tools. |
Inovalon |
Cloud-native tools for prospective risk adjustment, quality scoring, and audit preparedness. |
IQVIA |
Real-world analytics for evaluating cost-effectiveness and VB outcomes across populations. |
Lumeris |
Value-based operating system optimizing ACO and Medicare Advantage performance. |
MedeAnalytics |
Payer-focused business intelligence platform tracking quality, financial, and VB contract KPIs. |
Milliman |
Actuarial and data tools for shared savings optimization, bundled payments, and VB risk management. |
Optum |
AI-enabled solutions for provider alignment, utilization review, and VB financial performance monitoring. |
Oracle Health |
Cloud-based payer systems for VB claims processing, compliance, and financial outcomes tracking. |
Persivia |
Remote monitoring platform integrating SDoH into payer-side VB risk and quality models. |
Premier Inc. |
Analytics and collaborative tools supporting Medicaid MCOs and ACO quality management. |
Veradigm |
Data-driven insights for population-level risk management and commercial/public payer VB programs. |
Why This Matters for Health Plans and Managed Care Organizations Now
With CMS rapidly expanding alternative payment models, payers face increased responsibility for managing downside risk, quality transparency, and medical loss ratio compliance. States including New York, California, and Texas have aggressive Medicaid value-based purchasing mandates, intensifying pressure on Medicare Advantage and commercial plans to deliver measurable outcomes.
"Health plans can no longer afford reactive strategies," said Doug Brown, President of Black Book Research. "The vendors recognized in this report deliver proactive, quantifiable outcomes aligning closely with value-based mandates, making them essential partners for managed care executives at AHIP 2025."
About Black Bookâ˘
Black Book Research, celebrating its 20th anniversary in 2025, is the healthcare industry's trusted source for unbiased, crowdsourced satisfaction insights. This report, derived from a national survey of nearly nine hundred health plan IT users and payer executives with a 95% confidence level, benchmarks VBRO solutions supporting Medicare Advantage, Medicaid Managed Care, and commercial alternative payment models.
For licensing the full report or accessing benchmark analytics, contact research@blackbookmarketresearch.com or visit www.blackbookmarketresearch.com. Black Book also offers numerous gratis reports for stakeholders on the website.
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SOURCE: Black Book Research
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