$24B
Medicare Part C improper payments in FY2025 - a 6.0% error rate
CMS Improper Payments Fact Sheet (FY2025)
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HOW HILABS MCheck VBC Caresphere OUTPERFORMS LEGACY VALUE BASED CARE SYSTEMS
Legacy processes rely on manual workflows, siloed systems, and delayed insights. MCheck VBC uses AI-driven automation to validate attribution, detect anomalies in real time, and improve payment accuracy at scale.
Attribution & Program Accuracy
| Traditional Systems | VBC Caresphere |
|---|---|
| Manual attribution reviews limit coverage and scalability |  Real-time attribution validation across all provider groups and programs |
| Incomplete analysis leads to missed anomalies | Identifies anomalies with complete coverage |
| Reactive processes delay issue identification and resolution | Provides root cause analysis (RCA) for faster, actionable insights |
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 $23 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.
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)
Why Leading Payers Choose HiLabs AI-Driven Value-Based Care Solution
Comprehensive, AI-powered solution designed to detect, resolve, and prevent value-based care payment issues at scale
Intelligence Engine for Risk & Reconciliation
- Proactive Anomaly Intelligence
- AI-first detection of high-impact data and payment anomalies—prioritized by HiLabs proprietary scoring system to focus on the greatest operational and financial risk
- Multi-Model Payment Reconciliation
- Seamlessly supports PMPM, capitation, care coordination, and shared savings models with automated attribution and contract-aligned reconciliation logic
Attribution & Insights for VBC Acceleration
- Attribution-Driven VBC Adoption
- Enhances member attribution visibility and aligns high-potential providers to the right programs, boosting engagement and accelerating VBC adoption
- Smart Views & AI-Powered Tracking
- Track financial changes, variances, and trends with intelligent filters and dashboards tailored to business lines, rules, and regions for faster, data-driven decisions
AI-powered anomaly detection and intelligent insights driving financial accuracy and building provider trust
20,000+
Anomalies identified across member attributions and provider payments
5,500+
Provider groups analyzed daily for anomalous attributions
18M+
Financial transactions audited monthly for anomalous payments
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.
VBC Data Ingestion
All plan-specific inputs are captured and prepared for analysis.
Ingest VBC input data from multiple sources
Include member attribution, financial transactions, and payment models
Consolidate data for unified processing
Intelligent Data Analysis
AI models analyze data across multiple dimensions to identify patterns.
Perform time series analysis to track changes over time
Run variance analysis to detect deviations
Apply multivariate analysis for deeper insights
Anomaly Detection & Prioritization
The system identifies and prioritizes high-impact issues.
Detect anomalies across attribution and payments
Prioritize issues based on impact and severity
Surface critical discrepancies for action
Root Cause & Trend Analysis
Issues are traced back to their source with contextual insights.
Perform root cause analysis for detected anomalies
Analyze trends comparing target vs actuals
Provide actionable insights for resolution
Interactive Review & Decisioning
Users interact with insights through a flexible interface.
Use custom filters by LOBs, time, metrics, and thresholds
Enable user review and validation of findings
Support faster, data-driven decisions
Corrective Actions & Payout Optimization
Insights drive actions that improve payment accuracy.
Trigger corrective actions for identified issues
Ensure accurate provider payouts
Continuously improve VBC program performance
What Health Plans Should Look for in Value Based Care Software
Most VBC platforms were built for providers tracking quality. Here's what payers need for payment integrity, attribution, and financial accuracy.
- Real-Time Attribution Validation
- Member attribution errors are the #1 source of VBC payment disputes. Look for continuous validation that catches anomalies as they occur & not in a quarterly reconciliation cycle.
- Multi-Model Payment Reconciliation
- PMPM, capitation, care coordination, shared savings - each has different triggers. Your platform should handle all models natively, not force manual workarounds.
- AI-Powered Anomaly Detection
- Manual auditing catches a fraction. Look for AI that prioritizes anomalies by financial impact, surfacing the highest-cost issues first.
- Root Cause Analysis, Not Just Flagging
- Was it attribution? Contract mismatch? Data quality? Provider billing pattern? Your system should answer WHY, not just WHAT.
- Provider Trust & Transparency
- VBC programs depend on relationships. Give providers visibility into their attribution, payments, and variances building trust through transparency.
- Financial Impact Prioritization
- Not every anomaly carries the same financial risk. Impact-based scoring helps teams focus on high-value errors before minor discrepancies.
PROVEN RESULTS: DRIVING PAYMENT ACCURACY AND COST EFFICIENCY AT SCALE WITH MCheck VBC Caresphere
See how leading health plans improve attribution accuracy, reduce payment leakage, and drive measurable cost savings across value based care programs with AI-powered automation.
$5–6M in Operational Savings
HiLabs AI-driven anomaly detection and root cause analysis have significantly reduced manual effort, streamlined workflows and unlocked millions in cost savings
Significant Drop in Provider Abrasion
Accurate payments and real-time member attribution have driven transparency and trust, leading to meanignful reductions in provider disputes
Increase in VBC Program Adoption
With clearer insights and targeted engagement, provider participation in VBC programs has increased significantly across supported markets
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.
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.
What is a value based care model?
A value based care model aligns provider payments with patient outcomes, cost efficiency, and quality metrics. Health plans use value based healthcare models to manage risk, improve care delivery, and optimize performance across provider networks.
What is value based healthcare and how does it work?
Value based healthcare is a system where providers are incentivized based on care quality, patient outcomes, and cost savings. It works through structured value based care programs that track performance, attribution, and payments across populations.
What are value based payment models?
Value based payment models include approaches like capitation, shared savings, bundled payments, and PMPM (per member per month). These models require accurate attribution, contract configuration, and payment validation to ensure fairness and efficiency.
Why are value based care programs important for health plans?
Value based care programs help health plans control costs, improve patient outcomes, and ensure payment accuracy. They are critical for transitioning from fee-for-service to more sustainable value based healthcare models.
How do health plans manage value based care models effectively?
Health plans manage value based care models by automating member attribution, configuring contracts accurately, and monitoring payments through advanced analytics and AI-driven platforms.
What challenges exist in value based care in healthcare?
Common challenges include inaccurate member attribution, complex payment models, delayed anomaly detection, and lack of data transparency. These issues can impact payment integrity and overall program performance.
How can AI improve value based healthcare models?
AI improves value based healthcare models by enabling real-time anomaly detection, automated attribution validation, and root cause analysis. This helps ensure accurate payments, reduce leakage, and improve efficiency across value based care programs.
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