Sentara's Optima Health Selects Edifecs To Power Collaboration With Clinically Integrated Networks

Edifecs, a global health information technology solutions company, announced a strategic partnership with Optima Health, a service of Sentara, one of the nation's top integrated healthcare systems, to catalyze value-based reimbursement and care programs across its provider network.

Optima Health will be using the Edifecs Population Payment solution for modeling administering, monitoring and reporting on pay-for-value programs.

“We asked ourselves ‘How do we help providers help patients get the best care at the best cost?’” said Dr. Thomas Lundquist, Chief Medical Officer of Optima Health. “Optima Health is aggressively pursuing the analytics that will allow us to position ourselves as a payer of choice among our collaborative partnerships with clinically integrated networks. We are empowering our doctors to provide the best treatment regime, in context, at the lowest cost. Ultimately benefitting both our providers and the patients they serve.”

The Edifecs Population Payment solution delivers performance transparency and user-friendly dashboards that are easily readable for all stakeholders. These dashboards will provide a combined administrative and clinical view of patient utilization patterns and costs at a glance. With this visibility, providers can manage patient expectations, observe utilization patterns and better understand how patient care treatment recommendations align with KPIs and performance expectations.

With the rapidly increasing shift from volume-based healthcare to value-based reimbursement and care delivery models, health plans face challenges at every turn. Edifecs’ solution will help Optima Health promote provider buy-in by ensuring stakeholder visibility, measuring performance and analyzing the impacts of shifts in reimbursement models.

“We believe the work we are doing with Optima Health and Sentara will change the dynamic of the traditional payer-provider relationship,” said Sunny Singh, CEO of Edifecs. “Offering its network of providers this kind of transparency and visibility will drive tremendous value for the patients it serves and position the organization as a pioneer in the industry.”

Edifecs Population Payment
The Edifecs Population Payment solution delivers an integrated, automated approach to solving the most pervasive challenges health plans encounter with their value-based reimbursement and care delivery initiatives. The solution provides actionable insight into cost, quality and utilization information. The solution reduces health plan financial risk through ‘what-if’ analyses and risk-based population analysis. Workflow-driven administration simplifies complex operational processes.

About Optima Health
Optima Health, based in Virginia Beach, Virginia, provides health insurance coverage to more than 452,000 members.  With 30 years of experience in the health insurance arena, Optima Health offers a full suite of commercial products including consumer-directed, employee-owned and employer-sponsored plans, individual health plans, employee assistance programs and plans serving Medicare and Medicaid enrollees. Our provider network features 20,000 providers including specialists, primary care physicians, and hospitals. Optima Health offers programs to support members with chronic illnesses, customized wellness programs, and integrated clinical and behavioral health services as well as pharmacy management – all to help our members improve their health. Our goal is to provide better health, to be easy to use and offer services that are a great value. For more information, visit www.optimahealth.com.

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. For more information, visit www.edifecs.com.