Seamlessly share clinical information to improve care

And gain valuable insight across your healthcare partner ecosystem

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Value-Based Care

The Value-Based Care (VBC) solution combines the Population Payment Management and Population Health products to create an end-to-end, turnkey solution to scale value-based initiatives. Edifecs offers a single, scalable platform that supports modeling and program administration, clinical operations, population health and risk management.

A New Approach

Edifecs offers a turnkey solution to design, administer and optimize pay-for-value programs. The Edifecs Clinical Solutions are built on a Partnership Platform to support automated healthcare data exchange between payers and providers. Clinical data integration and continuous population monitoring increases the effectiveness of population health management partnerships required for success in value-based care.

Who We Help

Payers

We help payers model, design, operationalize and optimize pay-for-value programs and scale their population health partnerships with providers and other risk bearing stakeholders.

ACOs

We assist providers who participate in ACO programs by integrating payer claims with native clinical data to reveal actionable insights for closing care gaps, refining intervention strategies and improving care team decision making.

Government

We help government agencies to scale and evaluate the performance of expansion programs and quickly implement new payment programs on one platform.

International

Edifecs assists international government agencies in administering and scaling multi-payer programs. We offer a highly configurable solution that helps customers implement new standards for healthcare data interchange and operationalize value-based care programs.

Solution Overview

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Target and Design

Stratify at-risk populations assigned to providers. Design incentives and payment terms.

Build and Coordinate

Use all available data to build an integrated patient record, then coordinate care based on risk or conditions.

Intervene and Monitor

Configure thresholds for early detection of high-risk patients and populations.

Administer and Report

Ensure partners receive quality and program payments according to contract terms.

Solution Spotlight

  • Population Payment Management

    Edifecs Population Payment Management solves the most pervasive challenges health plans face with scaling their value-based care and reimbursement initiatives. These challenges are solved through targeting and modeling populations and financial arrangements, automating program management and enabling on-going program optimization.

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  • Population Dimensions

    Population Dimensions works with the Edifecs Intervention Gateway to provide the industry’s first disruptive population health management solution. By continuous acquisition, normalization and correlation of member data, Population Dimensions presents a clinician-friendly, shared view of the member health record across payer and provider settings at convenient points in the clinical workflow.

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  • Intervention Gateway

    Intervention Gateway integrates data in motion at the edge of the enterprise to dynamically deliver critical new insights and prescriptive actions to population health managers. Condition-specific learning engines increase population health management effectiveness with greater precision for early detection of changes in health risks, morbidity, network and services utilization, provider and patient behavior.

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Technology

The Partnership Platform represents the single integration point for Clinical, Financial and Administrative information received from disparate sources within the program infrastructure. The solution unifies program administration and clinical operations so that payers and providers can seamlessly model, operationalize, monitor, administer, and optimize their partnerships. The Partnership Platform tightly aligns program goals and care delivery operations. It provides integrated views of a patient and a population’s concurrent health and financial risk status with the context of their product affiliation, network and service utilization.


 

Capabilities

Population Payment Management

Edifecs Population Payment Management empowers health plans to target specific member populations and provider networks, model financial arrangements, administer value-based programs and optimize on-going performance. Financial risk is mitigated through "what if" analyses of shifts in reimbursement. The product improves health plan and provider performance, as well as provider buy-in of new care and reimbursement models, through actionable, real-time dashboards.

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Population Health

Population Health eliminates time lag between early detection of population health issues – including clinical risks, network leakage and contract non-compliance – and automatically triggers interventions. As real-time information streams-in, the interventions are triggered at the edge of the enterprise. The Edifecs solution scales value-based partnerships by replicating best practices across multi-stakeholder population health programs.

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