Accelerate the shift to value-based care
Design, automate, and administer value-based contracts for more accurate payments and faster scaling of value-based programs.
Connect. Monitor. Accelerate.
The complexities of value-based contracting and payments make it difficult for healthcare organizations to effectively monitor contract performance and ensure accurate payments. Not only does this affect their ability to create reliable financial forecasts, it also makes it harder to expand their value-based operations and move into more complex alternative payment models (APMs).
Edifecs’ cloud-native value-based payment solutions are purpose-built to connect payers and providers, deliver transparency, and establish a single source of truth in value-based programming.
Value-Based Payment & Insight Products
Population Payment Management
Accelerating the Shift to Value
Edifecs’ Population Payment Management solution can help healthcare organizations overcome those challenges and accelerate the shift to value.
With the ongoing shift to value-based care, today’s healthcare organizations have to manage complex programs with a wide variety of payment models across all lines of business. To do so effectively, they need sophisticated technology solutions that are designed to scale and support the full range of value-based programs and payment arrangements.
In this video, we outline how Edifecs’ Population Payment Management solution helps payers improve trust, transparency, and collaboration with provider partners to accelerate the growth of their value-based initiatives.
Learn how Edifecs can help your organization accelerate the shift to value-based care.
Frequently Asked Questions
01
Why is value-based care a priority for healthcare organizations?
Moving from traditional fee-for-service arrangements to value-based care—which emphasizes early intervention and ongoing patient engagement—offers a variety of benefits for health plans, providers, and patients.
VBC’s focus on preventive care helps reduce the likelihood of hospitalizations or the development of avoidable comorbid conditions, enabling better care outcomes and improving satisfaction and engagement for patients/members. This approach, coupled with more effective and patient-centered care coordination, helps minimize unnecessary expenses and reduces care costs across the healthcare spectrum.
02
Why hasn’t healthcare fully adopted value-based care?
Although CMS has set a goal of transitioning all Medicare beneficiaries and “the vast majority of Medicaid beneficiaries” to value-based care by 2030, many healthcare organizations have been slow to make the transition for a few key reasons:
- Poor transparency between providers and health plans
- Ineffective (or nonexistent) contract management systems
- Confusing or unclear quality and performance metrics
- Fragmented and siloed patient information
03
What are alternative payment models (APMs)?
Under the traditional fee-for-service (FFS) model, healthcare providers are financially incentivized to maximize visit volume—often at the expense of delivering more comprehensive care.
APMs reward providers based on the quality—not the quantity—of the care they deliver, empowering providers to take a more patient-focused approach that prioritizes preventive care and early intervention and supports better long-term health outcomes.
04
What are the most common APMs?
Though there are a variety of different APMs, some models have gained more widespread adoption than others. The most common APMs in use in healthcare include:
- Capitation – Providers are paid a set fee per patient over a predefined time period
- Pay for Performance (P4P) – Payments are tied to quality and efficiency performance measures
- Bundled Payments/Episodes of Care – A single payment encompassing all care associated with a specific treatment or condition
- Shared Savings – Incentivizes providers to reduce care costs by offering them a share of the costs saved
News & Insights
Elevate Value-Based Program Performance with Edifecs Value Insights
In this data sheet, we explain how Edifecs Value Insights helps reduce complexity and increase transparency to help payers and providers succeed in value-based care.
Value-Based Care Contracting
The value equation is simple – payment transformation through performance-based compensation aligns incentives across payers and providers to improve care delivery quality and population health while reducing cost. Learn how one large health plan designed and implemented payment models, managed operational change, and transferred knowledge across a variety of stakeholders to scale VBC programs efficiently and accurately with contracting and administration capabilities on a centralized platform.
Bridging the Gap: 3M & Edifecs Collaborating to Optimize Episode of Care Programs & Payments
Episode-based alternative payment models (APMs) can deliver more comprehensive care while reducing costs. Yet despite these benefits, many providers are hesitant to adopt episodic care due to the complexities and lack of specificity inherent in existing episode-based models.
Edifecs’ Population Payment Management combines with 3M’s Patient-Focused Episodes program to optimize episodic care programming and payments. In this white paper, we highlight the challenges of adopting bundled payments and explain how the right technology solutions can help health plans improve adoption and accuracy in episode-based care.