Edifecs Launches Agentic AI Platform to Cut Payer Costs and Scale Value-Based Care

Edifecs Launches AI-Driven Population Payment Management to Scale Value-Based Contracts with Confidence

September 22, 2025 - Edifecs, now a Cotiviti business, introduced the next generation of its Population Payment Management platform powered by agentic AI. The update targets the real issues management teams face in value-based payment (VBP): high administrative costs, slow settlement cycles, and inconsistent performance visibility.

The promise is straightforward: automate heavy operational work, reduce administrative and medical loss ratios, and give leaders real-time, decision-ready insights-without risking clinical decisions or compliance gaps.

Why this matters for management

• Lower admin and medical loss ratios by improving settlement accuracy and speed.
• Scale VBC programs without adding headcount by automating manual workflows.
• Gain clearer, faster visibility into contract performance for better financial planning.
• Maintain trust: AI is used for contract design and settlement-not medical necessity determinations.

What's new: agentic AI embedded in VBP operations

Edifecs' platform now uses intelligent, task-oriented agents that understand VBP program design and payment objectives. These agents detect context, trigger the right workflows, generate real-time insights, and execute complex analyses end-to-end.

• Virtual Jonathan (VJ): A next-gen data analyst agent. Ask questions in plain language to explore contract terms, analyze performance, and produce operational analytics-no SQL or report building required.
• Dashboard Agent: Converts natural language requests into customizable, interactive dashboards on the spot.
• Deep Research Agent: Surfaces trends, variances, and performance risks with guided recommendations to improve financial, quality, and operational outcomes.

Looking ahead, the Deep Research Agent will coordinate multiple agents through a model context protocol to solve complex analytical work that typically requires entire teams.

Built for oversight, privacy, and compliance

The approach prioritizes responsible deployment with human supervision. Agents support payment operations and analytics-not clinical decision-making. Data privacy, transparency, and regulatory compliance are standard, not optional.

Market context

VBP continues to grow. According to the Health Care Payment Learning and Action Network, value-based arrangements represented 45.2% of U.S. healthcare payments in 2023, up from 41.3% in 2022, with two-sided risk models reaching 28.5%. Source: HCP-LAN

Yet scaling VBP without straining budgets-and monitoring performance effectively-remains a sticking point for many organizations. Edifecs' agentic approach addresses both.

Executive perspective

"Value-based payments are essential to building a more sustainable healthcare system, but operational complexity has slowed progress," said Venkat Kavarthapu, EVP of operations at Edifecs. "By embedding intelligent agents directly into our Population Payment Management platform, we're helping our customers scale programs faster, cut costs, and improve performance."

Strategic backdrop: Cotiviti + Edifecs

Cotiviti completed its acquisition of Edifecs on March 31, 2025. The combined capabilities pair Cotiviti's strengths in data analytics and payment accuracy with Edifecs' leadership in interoperability and value-based care-aimed at improving efficiency, expanding alternative payment models, and supporting better outcomes.

What leaders should do next

• Run a quick audit: Identify top VBP contracts with settlement delays, high admin costs, or unclear performance signals.
• Pilot fast: Start with one or two programs where automation can cleanly replace manual tasks.
• Set clear KPIs: Time-to-settlement, admin cost per contract, variance detection speed, and MLR impact.
• Establish guardrails: Document where AI can act, where humans approve, and how exceptions are handled.
• Get your data ready: Standardize feeds and definitions to maximize the benefits of agentic workflows.
• Plan change management: Train teams to use conversational analytics and interpret recommendations.

Learn more

• Edifecs: www.edifecs.com
• Cotiviti: www.cotiviti.com

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