Edifecs to lead a panel on AI-driven approaches to improve alternative payment models

NASHVILLE, Tenn.–(BUSINESS WIRE)–Edifecs, Inc., a global health information technology solutions company, is moderating a panel discussion at the RISE National 2024 conference, March 17-19, 2024, in Nashville, Tennessee.

Summerpal Kahlon, M.D., Edifecs’ chief medical officer, will serve as moderator in the discussion featuring a national payer and a top provider, where the importance of AI, strategic data alignment, and empowering clinicians to adopt prospective risk adjustment practices when building collaborative alternative payment models (APM) will be explored.

In today’s marketplace, one of every four Americans is insured via a federal alternative payment model, in which unique risk, quality, and reporting mechanisms must be managed to ensure complete and accurate payments. At the same time, the government is actively investigating upcoding and overpayments, as well as addressing allegations of fraud. To traverse this tightrope, both health plans and providers need the right technological capabilities to realize improvements in care, quality, and cost.

During the event, Edifecs will showcase solutions that allow plans and providers alike to accelerate value-based payment adoption, more accurately manage population risk, and ensure adequate care funding. Artificial intelligence (AI) and interoperability have the potential to dramatically accelerate collaboration between payers and providers by enabling them to work together more transparently to improve alternative payment model performance. These technologies enable organizations to enhance risk acuity accuracy and minimize documentation errors, ultimately resulting in better care and better outcomes.

Edifecs will also feature its Best in KLAS interoperability platform, now including the FHIR API for prior authorization and electronic data interchange (EDI) capabilities needed to address all components of The Centers for Medicare & Medicaid Services (CMS) Interoperability and Prior Authorization Final Rule (CMS-0057-F). Edifecs is exhibiting at booth 505.


Payer/Provider Strategic Alignment: Lessons Learned While Building an AI Driven-Approach to Collaborative APMs: This session will highlight the use of AI solutions to ensure compliant diagnosis and coding gap closures for payers, gaining a better understanding of the covered population’s disease burden through comprehensive and predictive data. Dr. Summer Kahlon, M.D., chief medical officer at Edifecs, along with Edifecs’ customers and experts from Centene and Providence, will discuss the status of providers leveraging electronic health records (EHR) interoperable workflows to engage clinicians at the point of care to support accurate diagnosis, and potential performance improvements against operational and financial benchmarks.

WHEN: Monday, March 18, 1:00 p.m. – 1:45 p.m. CST

WHERE: Music City Center, Nashville, Tennessee


Dr. Summerpal Kahlon

Chief Medical Officer


Jennifer Holman, LPN, CRC

Director Risk Adjustment Programs


Deepak Sadagopan,

Chief Operating Officer, Population Health


#WhatIRun: Edifecs will feature its nationally acclaimed #WhatIRun campaign at RISE National 2024. The campaign elevates the visibility of women leaders in healthcare to inspire young women and girls in STEM. #WhatIRun is partnered with Allbirds to give away shoes to visitors at the Edifecs booth throughout the RISE conference. For every tweet that includes the #WhatIRun hashtag, Edifecs will donate $1 to the women’s health organization Bright Pink. For more information about the #WhatIRun program, visit: https://www.whatirun.org/

For updates on the latest news and announcements at RISE National, please follow @Edifecs on X, formerly known as Twitter.

About Edifecs

Edifecs provides market leading technology to its payer and health system customers, which serve nearly 300 million people in the U.S. healthcare market. For over 25 years, Edifecs has enabled customers to unlock greater value by aggregating, normalizing, and unifying data with its Best in KLAS interoperability platform. The Edifecs platform serves as the foundation for the solutions that eliminate stakeholder friction to overcome healthcare’s biggest challenges, including accelerating value-based payment adoption and obtaining more complete and accurate care funding for alternative payment models. Edifecs’ solutions incorporate natural language processing, machine learning, and artificial intelligence to provide deeper insights into patients, populations, and business processes. As new standards and regulations continually emerge from government agencies, Edifecs is a proven partner to ensure its customers maintain “evergreen” compliance. Edifecs customers include 24 of the 25 top commercial health plans in the country, 25 out of 36 of the Blue Cross Blue Shield payers, 32 of the 52 Medicaid programs, and 6 out of 10 of the largest health systems.


Janet Hohmann



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