Edifecs Buys Risk Adjustment Solution Vendors

Dec. 3, 2021
After buying Talix, company announces plans to acquire Health Fidelity with goal of providing a seamless risk adjustment solution

Edifecs Inc., a health IT company whose solutions focused on interoperability, workflows, value-based care payments, and analytics, is seeking to become a leader in risk adjustment with two recently announced acquisitions.

The Bellevue, Wash.-based company agreed to acquire Health Fidelity, a provider of risk adjustment solutions for the value-based care era, after buying Talix, another risk adjustment company, in September 2021.

The company said the planned acquisition is part of its strategy of becoming an industry leader in risk adjustment. San Francisco-based Health Fidelity’s technology uncovers insights that enable better care planning and more complete revenue capture, giving health plans and providers the ability to succeed in risk-sharing arrangements across Medicare Advantage, Affordable Care Act (ACA), Medicaid, and accountable care organization programs.

“I recently shared the news that we acquired Talix, another risk adjustment-focused solution provider,” said Venkat Kavarthapu, CEO of Edifecs, in a statement. “Each has unique and distinct capabilities which, when combined with our industry-leading workflows, will create a much stronger offering for all of our customers.” Edifecs said its goal is to provide a seamless risk adjustment solution without requiring its customers to pay for costly integrations and multi-vendor management overhead.

“In our analysis and diligence, it became clear that by combining the best of Edifecs’ existing risk adjustment portfolio with Talix, and potentially the complementary capabilities of Health Fidelity, we would be able to provide one of the most complete risk adjustment solutions in the market,” Sunny Singh, Edifecs founder and chairman of the board, in a statement. “Through the prospective acquisition of Health Fidelity, we are hoping to strategically integrate the unique and distinct capabilities of all three organizations to create an unrivaled risk adjustment portfolio that will be able to deliver value at every stage in the risk adjustment process.”

Edifecs plans to integrate Health Fidelity and Talix technology into its Encounter Management solution to provide customers the opportunity to operate risk adjustment processes more efficiently for Medicare Advantage, Managed Medicaid, and ACA products. When the acquisition is complete, joint customers will 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, the company said.

“This potential acquisition marks the beginning of a new, exciting chapter for Health Fidelity. Edifecs’ execution, service resources, and process strength, coupled with our innovative solution portfolio will be a powerful combination,” said Steve Whitehurst, CEO of Health Fidelity, in a statement. “We evaluated dozens of potential partners and it quickly became clear that our respective expertise and combined resources will propel clients to realize new levels of excellence in their risk adjustment programs,” he added.

The acquisition is expected to close in mid-December, pending regulatory approval.

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