Edifecs Grows Risk Adjustment Business Through Acquisition of Health Fidelity, a UPMC Enterprises Portfolio Company

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Health Fidelity, a UPMC Enterprises portfolio company that provides users with comprehensive, scalable risk adjustment solutions, was acquired by Edifecs, a health information technology solutions company, marking a major milestone in the growth of the company.

Health Fidelity was founded in 2011 as a health care startup focused on Natural Language Processing (NLP) technology for risk adjustment. Health Fidelity’s risk adjustment solutions are built on Lumanent® Insights, a best-in-class NLP inference engine that consumes unstructured data in the patient’s record and delivers actionable and accurate finding to coders and clinicians to support complete risk capture and high-quality care. Around this same time, UPMC Health Plan was experiencing an influx of new Medicare Advantage enrollments. When coupled with the rollout of additional Affordable Care Act (ACA) product lines, UPMC’s risk adjustment coders simply couldn’t keep up with the overwhelming workload.

UPMC began searching for solutions with the understanding that it would need to embrace a more comprehensive, data-driven approach built on a modern technology platform. That would include using tools such as NLP to help better manage coder workflows and improve productivity, which led directly to Health Fidelity.

In 2014, UPMC participated in Health Fidelity’s Series A funding, providing not only capital but also technical expertise, leadership, and Health Fidelity’s first customer – UPMC Health Plan. UPMC Health Plan tested Health Fidelity’s approach to optimizing risk adjustment on the payer side: applying NLP insights from clinical and administrative data to direct coder retrospective reviews within a single, integrated application. This includes the ability to tap into clinical staff, leverage available data, and access UPMC’s “living laboratory” to test out new or refine existing products.

Additionally, Health Fidelity has worked closely with UPMC Enterprises over the last several years on joint development activities to harden and augment the functionality and value of their technology.

“As an early strategic customer, partner, and investor in Health Fidelity, UPMC is proud to have played a significant role in helping Health Fidelity to 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. “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.”

In the coming year, Edifecs will integrate Health Fidelity and Talix technology into its signature Encounter Management solution to provide customers with the opportunity to operate risk adjustment processes more efficiently for Medicare Advantage, Managed Medicaid, and Affordable Care Act (ACA) products.

Read the full press release and visit the Health Fidelity website to learn more.

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