Shift from
Volume to Value
Health plans and providers are moving beyond analytics-driven pilots to full-scale operational value-based reimbursement (VBR) programs. Critical to this shift, is the alignment of financial and clinical data, administrative and contract automation, as well as transparency to control costs.
35% of all reimbursement will be value-based in the next 36 months1
MSSP programs to grow to 7.2 million lives in 20152
Over 50% of VBR contracts in the next 36 months will have downside risk3
Our goal is to have 85% of all Medicare fee-for-service payments tied to quality or value by 2016, and 90% by 2018.
Identify savings opportunities and design outcomes-based programs
Automate the administration of value-based contracts and programs
Enable proactive transparency and tooling to drive provider adoption
Decision support to market new ACO products to employers to improve competitive differentiation
Identify savings opportunities and potential revenue risks
Adapt to VBR programs from multiple payers without increasing administrative burden
Deliver timely and accurate insights into accounts receivable from VBR programs
Identify network leakage
Key Implementation Capabilities
Target Populations
Stratify at-risk populations assigned to providers. Identify partners with requisite quality, skills and patient access. Assess claims history to identify past payment trends.
Learn how Edifecs Population Payment Modeler can help.
Design Contracts
Develop baseline budgets and incentives to reward successful population health management partnerships. Identify metrics and measures that correlate to quality and cost control. Identify incentives and payment terms.
Learn how Edifecs Population Payment Modeler can help.
Assembled Integrated Patient Records
Access an “integrated member record” that combine administrative, financial and clinical data for sharing complete, longitudinal views of patient care.
Learn how Edifecs Population Dimensions can help.
Coordinate Care
Access to shared workflows across care teams to increase efficiency and improve care coordination.
Learn how Edifecs Population Dimensions can help.
Target Interventions
Configure thresholds for early detection of high risk patients and populations. Focus care management actions on patients with the highest opportunity for impact.
Learn how Edifecs Intervention Gateway can help.
Monitor for Compliance
Gather insights to detect changes in morbidity, health risk, patient behavior and compliance to protocols
Learn how Edifecs Intervention Gateway can help.
Measure Outcome
Match reported encounters, claims and payments to expected quality outcomes. Identify partners and populations at risk that could impact risk sharing/gain sharing payments.
Learn how Edifecs Population Payment Administrator can help.
Pay for Value
Ensure partners receive quality and program payments according to contract terms. Apportion shared savings across the care community.
Learn how Edifecs Population Payment Administrator can help.
Volume to Value Maturity Model
Have you been successful scaling your value-based programs that reduces costs and improves service across your populations?
Our experts can help.
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