Edifecs, Inc., a global health information technology solutions company, today announced the launch of its episodes of care with precision risk intelligence capabilities, the latest within Edifecs’ value-based care solutions. A more granular approach to bundled payment programs, these tools now offer health plans enhanced precision with member-level detail for a more accurate snapshot of a member’s health and the cost of care for an episode.
Today’s health plan organizations have difficulty designing effective episodes of care models that manage risk and variation and can fairly compensate providers caring for complex cases. These challenges, in addition to the lack of transparency throughout the care process, result in inaccurate predictions in the cost of an episode.
“Payment and payment prediction accuracy is a constant challenge for providers looking to participate in a bundling arrangement. From the macro concerns of population risk to the per-episode concerns of reimbursement risk, providers are historically hesitant to sign up for these programs due to the levels of uncertainty involved,” said Dr. Abhishek Jacob, vice president of Edifecs’ value-based solutions.
Built on their proven interoperability and compliance platform and powered through Edifecs’ Value-based Payment solution, the new embedded precision risk engine gives member-level risk adjustment intelligence for more accurate episodes of care payments. By leveraging available administrative, clinical, risk, and social influencers of health data the solution identifies episode-specific clinical and demographic markers which are then reviewed for clinical accuracy. Edifecs has designed these capabilities to train risk models for the right clinical and demographic factors long combined with the right business granularity, such as market, line of business, and product which is then calibrated for statistically significant markers. This allows for the right factors to adjust risk per member and per episode, instead of the more generalized approach used today that fails to capture the most costly nuances and variations of episodes of care.
“Edifecs is trusted by hundreds of the leading health plans across all service lines for solutions that remove friction and improve collaboration between payers, providers, and patients; enabling industrywide transformation and innovation. Our value-based payment platforms offer a much-needed level of transparency and accuracy to improve contracting, savings, and revenue between payers and providers,” said Venkat Kavarthapu, CEO of Edifecs. “By removing the risk adjustment burden from actuary teams, we are helping payers and providers save time and money, while also addressing challenges with operationalizing bundled payment models for episodes of care.”
The episodes of care and precision risk intelligence capabilities are available in the U.S. today as part of Edifecs’ value-based payment platform. The technology supports perinatal and oncology episodes with nearly a dozen more episodic scenarios in development which are expected to roll out next year.
To learn more about these solutions, please visit
https://www.edifecs.com/products/population-payment-management.
About Edifecs
Edifecs is a premier technology company in the US Healthcare market with solutions focused on interoperability, workflows, value-based care analytics, and payment programs. With innovative technology and solutions, Edifecs helps its customers by optimizing the secure exchange and processing of administrative and clinical data, reducing the cost of meeting various regulations, and automating workflows involved in multiple core processes within the healthcare ecosystem. Edifecs is a frontrunner in bringing new technology for B2B data exchange in healthcare streamlining business processes from “card to care,” and reducing the industry burden associated with data provisioning at the points of enrollment, care, payment, and reporting. With the advent of FHIR and new regulatory guidance from HHS, Edifecs has emerged as a leader in easing the effort associated with achieving compliance with new federal rules and in making the healthcare consumer the primary stakeholder. The company is headquartered in Bellevue, Washington, with additional offices in Atlanta, Georgia, San Francisco, California, and Mohali, India, an engineering center in Moldova, Belarus and Ukraine, and has more than 1,000 employees.
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