Tennessee Medicaid Program (TennCare) has selected Edifecs to help align its payment model with the Centers for Medicare and Medicaid Services’ (CMS) national payment reform initiatives. TennCare provides healthcare for approximately 1.5 million Tennesseans, covering approximately 20 percent of the state’s population, 50 percent of the state’s births, and 50 percent of the state’s children.
Edifecs’ Payment Reform and Value-Based Care solutions bring scalability to TennCare’s initiatives by providing near-time quality calculations, ongoing visibility into performance, and the capability to apply non-claims based measurement data to performance goals.
Top features of the Payment Reform and Value-Based Care solutions include:
· Centralized and consolidated platform for all program quality data entry and submissions
· Near real-time visibility of program metrics via role-specific dashboards, reports, and notifications
· Flexible quality engine for calculation of program-specific customized clinical and outcomes based-measures
· Ability to configure, group, monitor, and associate clinical quality values to all episodes in TennCare’s eight phase episode of care initiative
· Partnership with CNSI, an industry-leading firm specializing in large-scale, mission-critical IT implementations for many state and federal agencies, to integrate MC-Track® for provider compliance and collaboration
These payment reform initiatives will eventually lead to a model in which health care providers are rewarded for high-quality, efficient treatment of medical conditions and the long-term maintenance of their patients’ health. Clinically-focused measurements help drive provider acceptance and participation in value-based initiatives.
These payment reform initiatives will eventually lead to a model in which health care providers are rewarded for high-quality, efficient treatment of medical conditions and the long-term maintenance of their patients’ health. Clinically-focused measurements help drive provider acceptance and participation in value-based initiatives.
“States are taking a more active role in shaping payment terms between managed care companies and healthcare providers, and Edifecs recognizes the criticality of the healthcare industry’s successful transition to value-based,” said Sunny Singh, CEO of Edifecs. “We’re committed to helping our customers make these transitions as smooth as possible, ultimately helping to ensure that payments align with quality outcomes for the many patients affected.”
The company recently announced the successful implementation and go-live of the Nebraska Medicaid program’s new electronic data interchange (EDI) platform. Replacing the aging platform mitigates major risks by having transactions with significant volume (inbound claims and encounters) now deployed onto Edifecs’ Smart Trading Platform, a solution specifically designed to simplify data automation and streamline interoperability.
