The San Mateo Company Has Joined the Bellevue Firm’s Growing Risk Adjustment Portfolio
Health Fidelity’s risk adjustment solutions are built on Lumanent® Insights, a best-in-class natural language processing (NLP) and inference engine. By consuming unstructured data in the patient record, the engine delivers actionable findings to both payers and providers to support complete and accurate risk capture and high-quality care.
The early application of that engine toward the modernization and simplification of risk adjustment for payers was shaped by a market need for risk adjustment solutions that could offer better efficiency, accuracy, and scale. Today, value-based care enrollment is being utilized by nearly half the U.S. patient population, making solutions like Health Fidelity’s a critical tool to success.
“As an early strategic customer, partner, and investor in Health Fidelity, UPMC is proud to have played a significant role in helping Health Fidelity become a leader in applying NLP technology to the challenging industry-wide problem of risk adjustment—a critical issue for ensuring the best care for patients and appropriate reimbursement for providers in an era of value-based care,” said Brent Burns, board member of Health Fidelity and executive vice president of UPMC Enterprises, the innovation, commercialization and venture capital arm of UPMC. “As a continuing investor in, and customer of, the merged company, we are excited by its opportunities to serve more providers, insurers, and their patients.”
Health Fidelity was one of the first solution providers to extend risk adjustment technology beyond retrospective review, upstream into the clinical workflow, enabling providers to prospectively address risk adjustment through pre-submission and post-encounter reviews. As its technology grew, so too did its client portfolio: Health Fidelity now serves six of the 10 largest provider-sponsored plans and four of the top 10 largest non-profit health systems in the country.
“Despite its already significant impact, Health Fidelity’s journey is just beginning. Now acquired by Edifecs, our ability to innovate and scale is about to accelerate dramatically,” said Steve Whitehurst, Health Fidelity CEO. “The entire team is eager to push forward, join our new teammates, and get to work on generating high-quality analytics to improve care and inform operations, providing our customers even greater value.”
In the coming year, Edifecs will integrate Health Fidelity and Talix technology into its signature Encounter Management solution to provide customers the opportunity to operate risk adjustment processes more efficiently for Medicare Advantage, Managed Medicaid, and Affordable Care Act (ACA) products. With the acquisition complete, joint customers will ultimately have access to up-to-date claim and member information via Fast Healthcare Interoperability Resources (FHIR) application programming interfaces (APIs), highly scalable workflows, and mass actions that reduce the operational staff required to manage exceptions.
About Health Fidelity
Health Fidelity simplifies risk adjustment, offering risk-bearing organizations clear visibility into and control over the process. Through their NLP-powered solutions and expert advisory services, they uncover insights that enable better care plans and more complete revenue capture. The Lumanent® suite gives Health Fidelity partners the confidence to pursue and ability to succeed in risk-sharing arrangements across MA, ACA, Medicaid, and ACO programs.
Edifecs is a premier technology company in the US Healthcare market with solutions focused on interoperability, workflows, value-based care payments, and analytics. With innovative technology and solutions, Edifecs helps its customers by optimizing the secure exchange and processing of administrative and clinical data, reducing the cost of meeting various regulations, and automating workflows involved in multiple core processes within the healthcare ecosystem. Edifecs is a frontrunner in bringing new technology for B2B data exchange in healthcare streamlining business processes from “card to care,” and reducing the industry burden associated with data provisioning at the points of enrollment, care, payment, and reporting. With the advent of FHIR and new regulatory guidance from HHS, Edifecs has emerged as a leader in easing the effort associated with achieving compliance with new federal rules and in making the healthcare consumer the primary stakeholder. The company is headquartered in Bellevue, Washington, with additional offices in Atlanta, Georgia, and Mohali, India, an engineering center in Moldova, and has more than 750 employees globally. For more information about Edifecs, please visit www.edifecs.com.
About UPMC Enterprises
UPMC Enterprises is the innovation, commercialization, and venture capital arm of UPMC, a $23 billion health care provider and insurer based in Pittsburgh. With an emphasis on translational sciences and digital solutions, UPMC Enterprises provides its portfolio companies and partners with capital, connections and resources to develop solutions to health care’s most complex problems. Working in close collaboration with innovators from UPMC and the University of Pittsburgh Schools of the Health Sciences, as well as others worldwide, UPMC Enterprises strives to accelerate science from the bench to the bedside and has committed to investing $1 billion in novel drugs, diagnostics and devices by 2024.
Cain Brothers served as exclusive financial advisor to Health Fidelity in connection with the transaction.