A Long Day’s Journey into Value-Based Health Care

Download this case study and learn how one ambitious health plan provider is delivering on its value-based health care mission.

At its core, the goal of value-based health care is simple: deliver higher quality care at a lower cost by focusing more on the value of care provided rather than transactional care. Essentially, this is the shift away from fee-for-service to value-based reimbursement. However, this shift is far easier said than done. Challenges spanning from legacy systems, contracting and risk sharing issues, and a lack of actionable analytical insight all contribute to many organizations lacking the ability to engage in value-based health care initiatives or, at best, they engage in limitedscope pilot programs.

These challenges were not lost on a regional health care organization (both a health plan and a health system) that serves approximately half a million members. The organization, however, was committed to finding ways to solve these challenges and deliver on its mission of providing value-based health care through long-term clinical performance and risk-sharing agreements with its providers. This is the story of their journey into improving care coordination, clinical performance and cost of care.

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Edifecs Inc. is a global healthcare software company committed to improving outcomes, reducing costs, and elevating the value of healthcare for everyone. Edifecs delivers the industry’s premier IT partnership platform to providers, insurers, pharmacy benefit management companies, and other trading partners. By mobilizing its leading solutions at the front end of the healthcare information pipeline, Edifecs provides a unified platform for partners to flexibly pilot and scale new initiatives using their existing enterprise systems. Since 1996, hundreds of healthcare customers have relied on Edifecs partnership solutions to future-proof their leading initiatives in the midst of a dynamic healthcare landscape. Edifecs is based in Bellevue, WA, with operations internationally. Learn more about us at edifecs.com.

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