Edifecs Updates Tennessee Medicaid Program with Payment Reform Solutions

BELLEVUE, Wash.– Edifecs, Inc., a global health information technology solutions company, today announced it has been selected by the Tennessee Medicaid Program (TennCare) to support the agency’s payment reform and clinical quality initiatives. One of the longest standing Medicaid managed care programs, 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.

As part of a larger effort to change the way healthcare is paid for in Tennessee – away from paying for volume and toward paying for value – Edifecs has partnered with the state Medicaid agency to help align its payment model with the Centers for Medicare and Medicaid Services’ (CMS) national payment reform initiatives. 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.

TennCare is a leader in the move to value-based payment models. They are laser-focused on their goal to see a significant benefit to healthcare outcomes, while cutting the cost for the people of Tennessee,” said Fred Guthrie, associate vice president of Edifecs. “We are proud our solution is part of this transformation and to be partnered with TennCare to better serve their populations.”

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.

“CNSI is proud to bring its extensive managed care experience to our partnership with Edifecs,” added CNSI Chief Strategy Officer Sharif Hussein. “Tennessee is showing great initiative in the progression toward value-based care. We are honored to be a part of the effort and look forward to producing great benefits for the people of Tennessee.”

“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.”

About Edifecs

Edifecs develops innovative, cost-cutting information technology solutions to transform the global healthcare marketplace. Since 1996, Edifecs technology has helped healthcare providers, insurers, pharmacy benefit management companies and other trading partners trim waste, reduce costs and increase revenues. More than 350 healthcare customers today use Edifecs solutions to simplify and unify financial and clinical transactions. In addition, Edifecs develops supply chain management solutions to support worldwide customers in non-healthcare industry segments. Edifecs is based in Bellevue, WA, with operations internationally. Learn more about us at www.edifecs.com.

About CNSI

CNSI delivers a broad range of health information technology (IT) enterprise solutions and customizable products to a diverse base of federal and state agencies. We align, build and manage innovative, high-quality, cost-effective solutions that help clients achieve their mission, enhance business performance and improve the health for over 28 million Americans. Formed in 1994, CNSI is headquartered in Rockville, Maryland, with locations throughout the U.S. and India. CNSI employs a world-class team of technologists, program managers, and subject matter experts, all of whom have experience with large scale mission-critical IT implementations. Formed in 1994, CNSI is headquartered in Rockville, Maryland, with locations throughout the U.S. and India. CNSI’s website is: http://www.cns-inc.com.



Edifecs, Inc.
Janet Hohmann, 425-435-2894