Edifecs Expert to Speak at WEDI National Conference about the Next Phase of the Healthcare Exchanges and How Payers Can Compete

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After Largest Healthcare Expansion in 50 Years, Consumer Experience Moves to Forefront

Edifecs health information exchange expert John Kelly will discuss the new healthcare purchasing paradigm and how customer experience is key for payers to compete successfully in the insurance marketplace. The 23rd Annual WEDI National Conference in Hollywood, Calif., May 12-15 will focus on best practices for privacy and security, transactions and how to utilize the latest emerging industry trends, including an entire day dedicated to best practices for approaching ICD-10.

The session, “The New Healthcare Purchasing Paradigm: Why the Customer Experience is Paramount in the Ability of a Payer to Compete and Win,” will provide a better understanding of how the new healthcare market place will shift to a defined contribution model and the challenges the movement presents. Plans will need to be redesigned and payers will face increased pressure to meet consumer needs.

WHEN: Monday, May 12, 2014 at 2:20 p.m. – 3:20 p.m. PDT

WHAT: The Affordable Care Act is now less about the exchanges and more about creating a new market for the purchasing of healthcare. The emerging consensus is that the industry will move from a defined benefit to a defined contribution model, and the actual benefit will be purchased by consumers directly from both private and public exchanges. In such a world, the efficiency, flexibility and agility of the whole purchase-to-pay cycle needs to be radically re-engineered. Mr. Kelly will discuss best practice models for moving toward a more individual, consumer-centric process. He will review how customer experience will reign paramount in the ability for a payer to compete and win. This shift will put local and regional plans on more equal footing with national plans. The industry will see much more creativity and flexibility in plan design—similar to the industry patterns seen in the transitions from pensions to 401K's.

This session will also give attendees:

  •     Detailed information about the healthcare marketplace disruption and how it will change to a defined contribution model, and what this shift means for both private and public exchanges
  •     Increased familiarity with the purchase-to-pay cycle and how it needs to be revamped given the marketplace shift
  •     A deep understanding of the customer experience priority and how payers can compete by evaluating the type of coverage they are providing and to whom they are providing it

WHO: John Kelly, Principal Business Advisor at Edifecs, is a nationally recognized health information exchange expert. Kelly provides strategic consulting to Edifecs customers, specializing in information exchange and applying the principles of supply chain integration to the healthcare delivery lifecycle. His wide-ranging experience includes serving as CIO of healthcare network provider NaviNet, director of eBusiness Architecture at Harvard Pilgrim Health Care, and managing director of his own health IT consulting firm. Kelly also served as the architect and technical lead for the Commonwealth of Massachusetts’ statewide HIE project, developing a shared infrastructure for the Commonwealth, which supported both the health information and health insurance exchanges.

Edifecs will have a booth at the conference, showcasing its Operating Rules and Smart Trading solutions. For more information on the conference please visit WEDI.

About Edifecs, Inc.

An industry leader since 1996, Edifecs provides global healthcare information technology that reduces administrative cost, improves revenue sustainability, and increases collaboration and operational performance among health organizations, insurers, pharmacy benefit management companies, and other trading partners.

Today, more than 250 healthcare customers use Edifecs technology to unify financial, clinical and administrative transactions from multiple channels, while automating manual business processes such as enrollment, claims and payments management. Edifecs’ solutions and services support international and domestic compliance for HIPAA, Operating Rules and ICD-10. Edifecs’ supply chain management solutions also support over 50 general industry customers.

Edifecs is headquartered in Bellevue, WA with operations internationally. For more information, please visit http://www.edifecs.com.

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Kara Lundberg