The XpandVBB solution enables flexible and sophisticated benefit plan designs based on the value that a service or procedure provides to the consumer. As health plan administrators increasingly seek designs that align reimbursement, cost-sharing and consumer engagement, with clinical needs, clinical outcomes and clinical value, XpandVBB offers a solution for administrators to implement sophisticated value-based benefit designs. These designs are coordinated with specific care plan milestones, health management initiatives and other factors to incentivize the individual consumer to seek the appropriate care at the appropriate time with the appropriate provider.
Because the solution closely integrates with the administrator’s core claims system, the solution requires little or no additional work to configure new products or adjudicate/adjust claims once the underlying business rules and events are defined. In addition, tight integration permits accurate benefit payments for a specific consumer based on the consumer’s specific behavior and the value of the service to the consumer’s health. In short, XpandVBB allows an administrator to design different solutions for different consumers, based on the right combination of design, incentives and clinical effectiveness.
Integrated
Coordinates and synchronizes care plan requirements, core enrollment, benefit and claims data to provide consumers with a single, consistent product experience via the website and customer service
Scalable
Service-Oriented Architecture reduces or eliminates technical and product limitations, making it easy to manage benefits for a specific group of members or even specific members
Enabling
Facilitates desired value-based plan features by streamlining client and product configuration, integrating desired health management principles and optimizing wellness program integration
Real-Time
Empowers timely and accurate customer service due to adjudicating claims simultaneously with the core claim system, treating the value-based design as part of standard benefits, with real-time accumulators and contribution/payment postings
Synchronized
Expedites processing of medical claims based on specific value-based plan design elements, completing more accurate calculations in milliseconds, not days
Sophisticated
Using configurable business rules and interfaces with health management and wellness programs, the solution processes claims accurately and appropriately based on the design elements of the program regardless of the complexity
To learn more about value-based benefits, please see the information in our Knowledge Center or contact us to learn more.