Company says tech upgrades could save Medicaid millions

For nearly 10 years, Menomonee Falls-based Vestica Healthcare has been managing the complex needs of the health insurance industry using innovative technology to drive down the cost of health care. The company recently announced some improvements in the technology and process, which is continuously tweaked and developed by its sister company, Mequon-based Wonderbox Technologies LLC.

The company says the improvements could save the state of Wisconsin’s Medicaid program up to $2.8 million annually in third party administration contract rates.

Vestica Healthcare provides administration services to managed care organizations, health plans, government organizations, third party administrators and self-insured groups. The improvements and enhancements in the technology have allowed Vestica to significantly lower the internal cost of operations for the company to administer the program. Those cost savings would be passed on to participants in state of Wisconsin programs including Family Care, Partnership, Virtual PACE and Children’s Long Term Waiver, said Michael Lessila, director of business development for Vestica Healthcare.

“Our (enterprise system solution) is a software as a service model,” Lessila said. “We host the information onsite or in our data centers. It’s accessible from any internet connection, on your computer on your smart phone or on your tablet, and it is architectured in a way to promote ease of use and access to information.”

The enterprise system solution is capable of supporting claims management, enrollment, eligibility and premium billing, a state-of-the-art product definition system as well as reporting and profiling capabilities for the company’s clients.

The company currently has an existing contract with the State of Wisconsin for claims third party administrator services, which means any organization looking for TPA services has the option to select Vestica, Lessila said.

“We think we can automate the entire insurance process,” Lessila said.

Automation will help reduce the amount of mail and inquiry phone calls coming into a location.

“Our technology provides a web-based system that can be accessed anywhere, anytime by both members and providers to get the information they need. The portals allow them to instantaneously file claims, look up information, quickly process member eligibility and create profiling reports.”

According to Craig Kasten, chairman of the board of Vestica Healthcare, most large insurers or potential clients have very large mail rooms, and have people entering data and on the phone taking claims.

“There’s paper coming in from all over the place and accessing a particular claim can be difficult because of timing delays and so forth. We believe our technology can move those companies towards completely automating those processes and others.”

Vestica can do a much more efficient job on the administration profiling side as well as improving the access to information so that real decisions can be made, Kasten said.

Not only does Vestica use the products developed by Wonderbox Technologies, it also contracts the technology to other companies for use, Lessila said.

Vestica is currently working with organizations on a global level and only does a portion of its work in the state of Wisconsin.

“Our goal is to provide cost savings to the Medicaid programs in the State of Wisconsin and as a result, offer more residents the opportunity to receive quality health care services,” Lessila said. “We’re committed to Wisconsin and hope to eventually have a larger book of business locally.”