Offering innovative and distinctive healthcare IT solutions
Increase quality. Shorten time to market. Reduce medical and operating costs. Ensure compliance.
Value-Based Healthcare
It is possible to operationalize focus on health outcomes by steering on quality metrics while monitoring costs, and at the same time avoiding enhancements to core systems of health insurers and healthcare providers.
Our Solutions
Edifecs Value-Based Care is a single integration point for clinical, financial and administrative information received from disparate sources. The solution unifies end-to-end program management, identification of at-risk populations and evidence-based interventions to align program goals with care delivery operations.
Our approach delivers a turn-key solution to remove volume to value barriers by turning traditionally siloed data into usable intelligence for the entire enterprise.
Intervention Gateway and Population Dimensions
- Exchange administrative and clinical data and support patient adherence to care programs.
- Connect and enhance interactions to increase data quality and compliance.
- Offer secure, role-based access to time-based views of integrated healthcare events for care providers.
- Transform healthcare data into actionable clinical intelligence to deliver near real-time insights for healthcare partners to jointly manage their shared populations.
- Sharpens the care team’s ability to dynamically detect care gaps for patients who are monitored in population health and accountable care programs.
Population Payment Management
- Identify, align, and attribute appropriate provider and member rosters according to historical risk and cost stratification.
- Deliver value-based contract baseline and impact modeling, with ability to preview attribution, risk, and budgets, including “what if” analyses.
- Increase the adoption of Alternative Payment Models (APMs) among participating providers and payers by increasing visibility and alignment with financial and quality measures.
- Deliver a robust and highly scalable platform that enables bringing pilot projects to enterprise and community level.
- Provide business intelligence and reporting tools including dashboards and reports with drill-down capability with role based access.
Product Spotlight
Edifecs Trading Platform
With Edifecs Trading Platform, existing financial flows can be leveraged to capture fee-for-service payments and linking them to a Value Based Reimbursement program. Edifecs Trading Platform comes pre-configured with the relevant financial transactions from which the costs and certain health outcomes can be derived.
Edifecs Trading Platform also supports extending the flows with new quality related transactions (e.g. clinical information), which can be agreed between health insurers and healthcare providers. The Edifecs Population Payment Solution can then take into account these transactions in the overall Value Based Reimbursement program.
Edifecs Population Payment Solution
Edifecs Population Payment solution offers a template approach to Value Based Reimbursement programs and a very high level of configurability in terms of program parameters.
The templates are a combination of quality and financial parameters, which can be reused for new shared saving programs and can also be extended by changing the parameters and by changing or adding to the libraries of quality measures and financial agreements.
Capabilities
Edifecs Population Payment Administrator contains four main capabilities: Target, Design, Administer and Optimize.
Target and design
The target and design capabilities are offered to analyze and define the scope of the Value Based Healthcare program.
- Perform “what if” analysis to identify the impact of moving from fee-for-service to other value-based methodologies
- Perform "target population analysis", and define a population by plan and provider to examine performance on quality measures, cost drivers, stratify population risks, and more
- Use template-based design related to the type of healthcare, population, healthcare providers, quality measures and the corresponding financial arrangement
- Easily modify any and all program terms for analysis and modeling, share the program design and analysis for collaborative design, and review between health insurers and providers
Administer
With the administer capability the program can be monitored in near real-time, including financial settlement.
- This capability operationalizes the design; the actuals related to the defined quality measures and associated costs are shown on near real-time dashboards with drill down functionality
- The administrative functionality includes an engine which calculates the shared savings amounts for the stakeholders, based on the actual quality and cost performance
- Full visibility and transparency is offered in a secure way to authorized roles by storing all underlying transactions at the lowest level of detail
- Robust and highly scalable platform which allows scaling of pilot projects to enterprise and community level
Optimize
The optimize capability is offered to change the quality and financial parameters of the population payment program, which enables low cost experimentation.
- This capability allows changing quality KPIs, target values of KPIs and financial parameters like the weight of certain KPIs in the financial agreement
- Before the changes are applied, it shows the (financial) impact on the agreement
- Optimize programs through advanced data analysis to gauge retrospective and prospective utilization and medical cost trends, and gain insight on ways to improve outcomes
- Provides ability to perform "what if" scenarios against available data, such as "What changes to Program have greatest potential for impact on quality and cost?"
Contact us
- Main:
- 425-435-2000
- Sales:
- 425-435-2200
- Support:
- 855-333-4462