$1.5B+
Annual VBC payments monitored
Featured In
Impact of VBC Intelligence
22M+
VBC transactions processed
16M+
Lives under management
6K+
Provider groups monitored
$80M+
Payments flagged for review
Four products. One intelligent core.
Smarter decisions across every VBC program. Each product is deployable on its own and stronger with the others.
Portfolio Xcelerator
Catches bad economics and misconfigured terms before a contract goes live — and keeps the margin story visible after it does.
Simulate before you sign. Model proposed terms across the portfolio, not one contract at a time.- Catch drift before go-live. Executed contract cross-validated against the configured build.
- Forecast the margin. Predictive analytics on portfolio performance, plus buried contract language on demand.
CostIntel
Turns payment leakage into recovered margin, and catches the member who is about to leave.
- Audit the attribution. Track member movement continuously and prove who was attributed, when and why.
- Reconcile every payment. Decompose the final payout to the attribution, settlement or contract factor driving it.
- Save the switch. Flag members at risk of churning early enough for a proactive intervention.
CareIntel
Action-driven care optimization platform, ensuring no signals are missed and enabling proactive intervention
- Prioritize. Act. One surface to identify the most time-sensitive panel priorities across and ensure timely interventions
- Holistic care signals. Key KPIs across all care domains with AI-powered summaries surfacing the most important signals
- Chat for custom analytics. Care teams ask in plain language to get insights on the same data at their fingertips
CMS Sentinel
Turns regulatory change from a surprise into a schedule.
- Watch the whole rule stream. Every CMS release tracked against your book, continuously.
- Price it in dollars. Contract-level financial exposure, not another summary memo.
- Remediate before bids lock. Months of lead time, while the movement is still salvageable.
* CareIntel and CMS Sentinel are evolving
Same workflow. Errors found four steps earlier.
CareSphere doesn’t replace how your VBC programs run. It moves the moment of discovery to the left.
| Legacy VBC workflow | HiLabs-augmented workflow |
|---|---|
Contract executed and configured by hand | Terms simulated, then validated against the build |
Members attributed on visit history | Misconfigurations flagged pre-go-live |
Payments issued to providers | Attribution locked predictively, churn forecast |
Provider disputes the settlement | Settlement recomputed independently before payment |
Manual root cause, months later | Anomalies ranked by dollar impact, root-caused automatically |
Retroactive correction, relationship damaged | Corrected payment and shared evidence with the provider |
The Scale of Payment Errors in Value Based Care
When 60% of payments are tied to VBC models and improper payments in Medicare Advantage alone exceed $24 billion, payment integrity isn't a back-office function - it's the financial foundation of every VBC program. Yet most platforms focus on quality metrics, leaving payment reconciliation to spreadsheets.
$24B
Medicare Part C improper payments in FY2025 - a 6.0% error rate
CMS Improper Payments Fact Sheet (FY2025)
38%
Of payer executives say payment accuracy is their #1 operational priority
HealthEdge 2026 Annual Payer Survey
60%
Of US healthcare reimbursement now tied to value-based models
HCPLAN, via McKinsey (2025)
92%
Of payers reported VBC contract growth in 2024, acceleration expected through 2026
Persivia (Jan 2026)
92%
Of payers reported VBC contract growth in 2024, acceleration expected through 2026
Persivia (Jan 2026)
Augment the payer stack. Don’t replace it.
Not four standalone products. The same healthcare-trained AI, data foundation and audit trail.
The second product deploys faster than the first.
- Proven at Scale
- Time-tested VBC engines delivering value at enterprise levels, not in pilots.
- Audit-Ready Design
- Every output traceable, defensible, and reproducible.
- Faster Time to Value
- Trained on domain-specific intelligence for faster implementation and adoption.
- Future proof and scalable
- Any data in - one proven intelligence layer out.
From Plan-Specific Inputs to Trusted Outputs in Value Based Healthcare Models—In Real Time
MCheck VBC transforms fragmented inputs into validated insights, enabling real-time anomaly detection, root cause analysis, and accurate provider payouts across value based care programs.
Every product pays for itself in the first year.
Modeled on a reference payer: 2.5M members, $17.5B premiums, 1.5M VBC-attributed lives, 450K MA lives.
$3.9M
Year-1 investment
Full four-product suite, on existing data.
$13.6M
Returned in year one
Leakage prevented, settlements corrected, bonus protected.
3.5mo
Time to value
Blended; individual products land in 3–7 months.
6.5x
Net ROI over 3 years
$58.1M net benefit at $31.9M annual run-rate value.
COLLABORATE TO TRANSFORM VALUE BASED HEALTHCARE OPERATIONS
- Outcome-Led Transformation
- Strategic roadmaps and execution frameworks designed to deliver measurable business impact at enterprise scale.
- Operational Excellence in Execution
- Deep partnership, disciplined governance, and proactive change management to ensure seamless adoption and sustained performance.
- Customer-Centric Continuity
- Proactive issue resolution and continuous operational oversight to maximize resilience, stability, and business continuity.
BEYOND VBC, PROVIDER DATA MANAGEMENT SOLUTIONS, BUILT FOR SCALE
Purpose-built platforms that bring accuracy, intelligence, and automation across provider data, networks, contracts, value-based care, and clinical operations.
VALUE BASED CARE MODEL: Frequently Asked Questions (FAQs)
What is value based care in healthcare?
Value based care in healthcare is a model that rewards providers for delivering high-quality outcomes rather than volume of services. It focuses on improving patient outcomes while reducing costs, making it a core part of modern value based healthcare strategies.
Why are value based care programs important for health plans?
They help health plans control costs, improve patient outcomes, and ensure payment accuracy which is critical for transitioning from fee-for-service to more sustainable models.
What should health plans look for in a VBC platform?
Member attribution errors are the #1 source of VBC payment disputes. Look for continuous validation that catches anomalies as they occur - not in a a quarterly reconciliation cycle. Platforms that rely on batch processing systematically miss the window to correct errors before they affect payments.
What challenges exist in value based care?
Common challenges include inaccurate member attribution, complex multi-model payment structures, delayed anomaly detection, and lack of data transparency - all of which directly impact payment integrity and program performance.
How does the VBC platform detect payment anomalies and does it prioritise by financial impact?
Manual auditing catches a fraction of payment issues. Look for AI that priorities anomalies by financial impact - surfacing the highest-cost issues first rather than flagging everything equally and leaving prioritisation to your team.
How do VBC platforms support provider trust and transparency?
VBC programs depend on relationships. Providers need visibility into their attribution, payments, and variances - without having to file a dispute to get answers. Platforms that create transparency build the trust that sustains long-term VBC adoption.
How do health plans use HiLabs to manage value based care models effectively?
By automating member attribution, configuring contracts accurately, and monitoring payments through AI-driven analytics. The shift from manual workflows to continuous, automated monitoring is what separates plans that manage VBC effectively from those that are perpetually catching up.
How does MCheck® VBC CareSphere use AI to improve payment accuracy across VBC programs?
AI enables real-time anomaly detection, automated attribution validation, and root cause analysis ensuring accurate payments, reducing leakage, and improving efficiency across VBC programs without scaling analyst headcount proportionally to program growth.
RELATED ARTICLES: VALUE BASED HEALTHCARE
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