Supercharging Value-Based Program Growth with Edifecs
The healthcare industry as a whole is steadily moving towards value-based care, but some health plans take longer than others to make that transition. The timeframe depends on the plan’s member population, the complexity of their value-based contracts, and their ability to collect and harness the vast amounts of data needed to deliver value-based care.
In the race to value-based care, our customer—a member-owned health insurer serving over 20 million members nationwide—was falling behind. Historically, the plan had created its own solutions to manage ACO and capitation programs. However, that approach required a significant amount of time and resources, which meant the plan could only implement one or two new programs per year.
To meet the needs of their large and diverse member base, the plan needed to implement a variety of complex value-based contracts and establish a unified data infrastructure that could handle it all. In this case study, we share how our Population Payment Management solution helped streamline value-based contracting and administration, enabling the plan to grow their value-based contracts by over 1300%.
Edifecs, a Cotiviti business, helps healthcare payers and providers tackle some of their most complex challenges by delivering technology that increases transparency, improves collaboration, and drives down medical and administrative costs. By streamlining operations, advancing healthcare data interoperability, and enhancing claims payment efficiency, Edifecs enables organizations to achieve more effective and value-based care.
