1. SOLUTION BRIEF
www.edifecs.com (continued)
Edifecs Clinical Solution
Are you successful in enabling integrated healthcare partnerships?
The ability to deliver health economic value in the current dynamic marketplace is not an elusive goal. It is an achievable state of
operations that you and your key partnerships can champion through shared business intelligence. It’s the kind of business
intelligence that results in a triple win: Brand Growth, Brand Loyalty and Market Differentiation.
Now, more than ever, key relationships between payers and providers—and the systems that support their business
connection—directly drive the brand growth and loyalty of your customers. This is seen in the current healthcare reform
initiatives where success relies on critical collaboration in sharing business and clinical intelligence between these two parties.
In order to sustain an environment for health economic value growth, payers and providers need to support an integrated
business platform that promotes collaboration in a holistic manner. For example, the table below highlights some of the key
business and clinical domains with the corresponding capabilities considered essential.
REQUIRED CLINICAL CAPABILITIES
▪▪ Stratify disease conditions/prioritize risk members
▪▪ Share clinical outcomes and trigger partner workflow
▪▪ Report performance measures
▪▪ Calculate risk for non-compliance
▪▪ Incorporate quality insights into care coordination/care management
▪▪ Communicate care gaps and care plans in a timely manner to influence care coordination decisions
PAYER-PROVIDER DOMAINS
▪▪ Prevention and Wellness
▪▪ Care Management
▪▪ Regulatory Mandates and
Healthcare Reform
▪▪ Disease Management
▪▪ Utilization Management
▪▪ Revenue Cycle Management
▪▪ Product and Program
Innovation
Table 1: Domains and capabilities of Edifecs Clinical Solution
Payer Provider
Member Patient
Customer
Share dataShare intel
However, the financial and clinical indicators for assessing the health economic value of your membership is driven by business
intelligence insights that your classic systems may not be equipped to provide.

2. www.edifecs.com (continued)
Edifecs Clinical Solution
How Edifecs Enables Integrated Healthcare Partnerships
Edifecs Clinical Solution enables real time access to intelligence between payers and providers in order to achieve new
levels of health economic value. This is accomplished by enabling payers and providers to identify, define, monitor and
respond to value triggers across partnerships in an agile platform that:
▪▪ Validates and links incoming clinical, administrative, and financial data with historical information to create
comprehensive patient- and member-centric records
▪▪ Enables stakeholders to set clinical and financial risk markers in order to respond jointly to care interventions
that impact utilization management and medical loss ratio targets
▪▪ Provides administrative cost savings by eliminating the need to maintain dual administrative and clinical
infrastructure
Readmit PreventionCare PlanHigh Risk Grouped
Payer Provider
Notified of admit
Medical history
Member Record
Payer Provider
Flagged for Results
Payer Provider
Discharge Summary
Payer Provider
Performance Reporting
Rx Labs
Impacts
EDIFECS
Clinical
Solution
ADMISSION SUMMARY RESULTS CLAIM DISCHARGE CLAIM
PCPHospitalHospital CardiologistMale, 52, smoker
and diabetic arrives at
ER with chest pain and
shortness of breath
Labs Rx
admitted orders results prescribeER discharge
planning
follow-up/
referral
INTELLEGENCESOLUTIONWORKFLOW
Edifecs Clinical Solution in Action
The scenario below illustrates how the Edifecs Clinical Solution enables payer-provider data sharing for the most
intensive care coordination events their customers might face, across the continuum of care.

3. Edifecs develops innovative, cost-cutting 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, clinical and administrative 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.
©2014. Edifecs Corporation. All rights Reserved. May, 2014
Edifecs Clinical Solution
EDIFECS CLINICAL SOLUTION CAPABILITIES
▪▪ Proactive, automated insights on key risks markers and gaps in care enable payers and providers to target
intervention early and impact both costs and quality metrics
▪▪ Secure messaging on patient needs, which seamlessly integrates into existing health records and care
management systems to further strengthen collaboration efforts
▪▪ Reduction of risks and costs of readmissions by combining clinical and financial discharge records for more robust
health records as well as an advantageous continuum of care for patients
▪▪ Improvement in costs of care and clinician productivity through timely insights that reduce redundancy and
better coordinate patient care safety
HEALTH ECONOMIC VALUE
BENEFITS
▪▪ Reduce costs and increase
quality performance
▪▪ Support any integration
needs through shared access
to data
▪▪ Automate and scale near-
now care interventions
▪▪ Remove redundancy
Table 2: Edifecs Clinical Solution capabilities