Population Payment Management

Empowering Providers with data-driven insights to support value-based care contracting and administration

Value-based care arrangements between Payers and Providers are primarily driven by Payers. This imbalance in arrangements results from a lack of transparency into Payer data, modeling formulas, and methodologies, and financial, quality, and contractual performance. With Edifecs value-based care solution, Providers have access to data and insights to support value-based initiatives from joint program design to deployment, including continuous monitoring and optimization of value-based program performance.

Infographic - Population Payment Management for Providers

Features

Improve Information-Sharing Across Stakeholders

  • Leverage advanced data processing, analytical, and reporting capabilities
  • Enhance data stack with data-agnostic capabilities in terms of types of data that can be ingested and leveraged (for example, administrative, financial, clinical, pharmaceutical, quality, and so on)
  • Access a single data source of truth with the ability to aggregate data from multiple stakeholders including Payer, Provider, and government entities

Increase trust in the quality of data with advanced processes in data collection, validation, transformation, integration, and aggregation

Gain Critical Insights for Greater Impact

  • Analyze and optimize the performance of past, present, and future value-based programs to ensure mutually beneficial outcomes and cost savings
  • Compare the performance of value-based programs with other network Providers
  • Improve stakeholder coordination, alignment, and satisfaction through transparency in payment methodology and real-time reporting of auditable, and accurate data

Gain real-time insight into financial, quality, and contractual performance, which facilitates continuous monitoring and optimization of value-based arrangements

Increase Transparency into Payment Reconciliation

  • Ensure accurate payment reconciliation, auditing and reporting with user-controlled look-back options for more than 5 years of historical data
  • Gain predictive insight into future cost impacts and changes to payment arrangement and/or methodology
  • Identify value-based opportunities through the analysis of historical and ongoing programs

Track and audit the complex financial adjustments for monthly PMPM payments and various contract reconciliations