Edifecs Inc. is a global health information technology solutions company. TennCare is Tennessee’s state Medicaid program. On July the 26th, Edifecs announced it had been selected by the TennCare agency to aid their payment reform and clinical quality schemes. TennCare is one of the longest running Medicaid managed care programs in the United States. To day, approximately 1.5 million Tennessee residents receive medical care, thanks to TennCare. In fact, TennCare covers roughly 20% of the state’s population, 50% of births, and 50% of the children in the state.

The initiative will attempt to change the way healthcare is paid for in the State of Tennessee. The goal is to shift the payment system away from volume and towards paying for value. Edifecs will attempt to help the state better align its payment model with the national payment reform initiatives designed by the Centers for Medicare and Medicaid Services. Edifecs’ Payment Reform and Value-Based Care solutions will be perfect for this precise purpose.

The solutions will bring scalability to TennCare, while providing almost real-time quality calculations, ongoing visibility and the options of applying non-claims based measurement data to the agency’s performance goals. The most notable features of the Payment Reform and Value-Based Care solutions are as follows.

  • Centralized and minimized platform for data entry and submissions
  • Program metrics are available in near time through role-specific dashboards, reports and notifications
  • Quality engine provides calculations for customized clinical and outcomes based-measures
  • Partnership with CNSI allows for the integration of MC-Track for provider compliance and collaboration

After the payment reform initiatives go into effect, TennCare will eventually be able to reward health care providers for high-quality and efficient treatment of Tennesseans. To learn more about Edifecs and their partnership with TennCare, be sure to check the press release here.