Drive Value-Based Purchasing Initiatives

Improve Program Adoption, Scalability and Outcomes

Value Based Purchasing

The shift in the healthcare industry from volume-based reimbursement to value-based will continue unabated. And that shift is occurring not just at the health plan level, but the state level as well. Also, just as with health plans, state-based payment reform initiatives face substantial, yet surmountable, challenges in facilitating change including: MCO/ACO/provider adoption, program scalability, program performance management, turning disparate data into actionable insights

Our Solution

Edifecs Value-Based Care enables State Medicaid Agencies to support a broad spectrum of alternative payment models including shared savings and episodes of care, manages the operational needs of these initiatives including financial modeling, population analytics, design, incentive administration and data sharing requirements.

Standard and configurable templates drive easy adoption of state-specific definitions for the most common value-based programs. Executive dashboards, reports, and workflow make data sharing across value-based stakeholders transparent, accurate and auditable.

Actionable insights coupled with peer comparisons foster the curiosity and competition to help drive the desired behavior.

Capabilities

Operationalize and scale payment reform initiatives

COTS based solution for your payment reform needs

 

  • Support simultaneous payment models, each with varying goals and populations.
  • Automation of all program design, monitoring, analytics and settlement in a single solution.
  • Out of the box templates covering the CMS APM framework.

Accelerate program scalability & improve visibility

  • Reduce administrative burden for all stakeholders (State, Managed Care Plan and Providers).
  • Phased approach from fee-for-service to gain sharing and risk sharing.
  • Enable transparency, accountability and standardization of program execution.

Maximize data intelligence while reducing data fatigue

  • Enhance quality performance monitoring and reporting.
  • Enable care coordination and clinical evidence-based alerting.
  • Deliver point in time macro and micro level reporting and monitoring.
  • Aggregate disparate data including, financial, administrative, clinical and custom data.