VBRO technologies emerge as essential investments for payers navigating CMS and state-driven payment reforms, according to 849 executives polled pre-AHIP 2025
LAS VEGAS, NV / ACCESS Newswire / June 16, 2025 / In the lead-up to AHIP 2025, a national survey conducted by Black Book Research reveals that an overwhelming majority of attending payer executives and health plan leaders have identified Value-Based Reimbursement Optimization (VBRO) as their organization's top strategic IT focus in 2025.
The survey, conducted across 849 managed care executives, half of whom are AHIP 2025 attendees, highlights how rapidly accelerating federal and state mandates around alternative payment models (APMs) are driving investment in scalable, payer-focused reimbursement technologies.
"Health plans can no longer afford to be reactive," said Doug Brown, President of Black Book Research. "The vendors identified in this report are not only satisfying clients, they are enabling measurable improvements in risk management, cost containment, and value-based outcomes."
Performance Impact from Leading VBRO Vendors
Health plans already implementing top-rated VBRO platforms report up to 81% improvement in key metrics, including:
Risk adjustment accuracy
Cost savings and financial performance under APMs
Outcomes--based contract compliance
Star Ratings improvements for Medicare Advantage
States including New York, California, and Texas are also rolling out aggressive Medicaid value-based purchasing models, making advanced VBRO systems crucial for payers seeking to remain compliant while optimizing member outcomes.
Top 20 Vendors Recognized for Value-Based Reimbursement Optimization in 2025
Alphabetically Listed | Based on Health Plan and MCO Client Feedback
Vendor | Recognized VBRO Capabilities |
|---|---|
Arcadia | Population health analytics to support quality tracking and member risk stratification. |
Carelon Digital Platforms | Member engagement tools driving care gap closure and Star Ratings performance. |
Cedar Gate Technologies | Bundled payment modeling and analytics for shared savings and downside risk. |
Cotiviti | Integrated payment integrity and quality monitoring aligned with value-based incentives. |
FinThrive | Predictive VB payment modeling and real-time revenue insights for payers. |
FTI Consulting | Strategic advisory for transitioning to outcome-based payment models. |
Gradient AI | Predictive underwriting and VB contract performance forecasting. |
HCL America | VB infrastructure support and CMS-compliant payment model integration. |
HealthEdge | Automated VB contract administration, claims integration, and provider reporting. |
Innovaccer | AI-driven VB analytics platform supporting risk management and member targeting. |
Inovalon | Cloud-based risk adjustment, audit readiness, and quality scoring tools. |
IQVIA | Real-world data analytics for population cost-effectiveness and outcomes measurement. |
Lumeris | Operating system for value-based care, supporting ACO and Medicare Advantage plans. |
MedeAnalytics | Business intelligence tools focused on VB payer performance and contract KPIs. |
Milliman | Actuarial tools for optimizing bundled payments, shared savings, and VB risk. |
Optum | AI-powered tools for provider alignment, utilization, and financial performance tracking. |
Oracle Health | Payer solutions for VB claims processing, compliance, and outcome management. |
Persivia | Remote monitoring integrated with SDoH data for VB quality and risk scoring. |
Premier Inc. | Collaborative Medicaid and ACO analytics for value-based program execution. |
Veradigm | Commercial and public payer solutions for risk management and VB program alignment. |
Why This Matters for AHIP 2025 Attendees
With CMS expanding downside-risk APMs and more states imposing value-based purchasing mandates, payers are expected to deliver measurable improvements in care quality, population health, and financial transparency. VBRO platforms are evolving into foundational IT investments-not optional upgrades.
The vendors in this report reflect high client satisfaction and impactful results reported by executives managing Medicare Advantage, Medicaid managed care, and commercial health plans.
About the Survey and Black Book Research
Black Book's 2025 VBRO survey includes responses from 849 managed care and health plan leaders, with a confidence level of 95%. Respondents graded vendors on 18 qualitative key performance indicators including solution adaptability, ROI, contract alignment, innovation, and client responsiveness. Black Book Research, now in its 20th year, delivers impartial, crowd-sourced client satisfaction rankings and benchmark analytics to help payers, providers, and investors make better-informed technology decisions. Contact research@blackbookmarketresearch.com
www.blackbookmarketresearch.com
Contact Information
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SOURCE: Black Book Research
View the original press release on ACCESS Newswire:
https://www.accessnewswire.com/newsroom/en/healthcare-and-pharmaceutical/health-plan-executives-at-ahip-2025-align-strongly-on-value-based-rei-1039874
