Introducing HealthEdge Innovation Lab

As healthcare pioneers, HealthEdge understands the challenges of turning an idea into a real-world solution. Even some of the best ideas need nurturing to help them evolve. That’s why we started the HealthEdge Innovation Lab. We believe every idea should have the chance to grow and every innovator should have a place to help them make that happen. The HealthEdge Innovation Lab is the next stop in the evolution of an innovator.

The HealthEdge Innovation Lab offers digital health disruptors a place to develop, test, and evolve their ideas by providing access, education, and support.

Access – We help startup and early-stage companies mature and grow their businesses through access to:

  • Client database
  • Marketing
  • Research firms
  • Co-development

Education – We provide a structured education program that includes:

  • Mentorship
  • Access to experts
  • Agile framework

Support – We nurture and support your unique vision through:

  • Ecosystem placement
  • Design assistance
  • Long-term vision
  • Partnership collaboration

Driving Transformational Change

We partner with digital health innovators to revolutionize healthcare and drive transformational outcomes, including:

  • Member engagement and satisfaction
  • Cost reduction
  • Operational efficiency
  • Growth & innovation
  • Business agility
  • Provider satisfaction
  • Data sharing
  • Accurate claim payments
  • Clinical workflow management

We believe in purposeful partnership

Our vision is innovating a world where healthcare can focus on people. The HealthEdge Innovation Lab supports healthcare pioneers with:

  • True partnership designed to help startup and early-stage companies mature and grow their business
  • Expertise and mentorship programs to educate and inform on the challenges and obstacles that often confound the healthcare industry
  • Deliberate orchestration of services to unravel the tangled web of healthcare ecosystems and bolster long-term vision and goals

Join the healthcare pioneers  

We want to hear how your organization is innovating and disrupting the status quo! Learn more about the HealthEdge Innovation Lab here.

Innovation at HealthEdge: Making Waves in Healthcare Payer Technology

The journey of transforming healthcare starts with innovation. We recently sat down with Sanjeev Sawai, Chief Innovation Officer at HealthEdge, to understand how innovation can be traced to the roots of HealthEdge and what innovation looks like going forward.

What is HealthEdge’s role in the digital transformation of the healthcare landscape?

To keep up with digital disruption in the healthcare industry, payers need intelligent, next-generation solutions. Payers who do not invest in next-generation technology will likely be left behind. HealthEdge offers modern, flexible, and inter-operable solutions that pave the way for payer strategies to meet tomorrow’s shifting market demands. HealthEdge accelerates digital transformation in healthcare through facilitating real-time transactions, integrating applications with IT systems, and making real-time data available.

How will HealthEdge provide health plans with data and technology to support the entire healthcare ecosystem?

At HealthEdge, we understand that the payer ecosystem is large and complex. That is why all HealthEdge products are built to seamlessly integrate with all vendors and technology needed for our customers to do business. Our focus is on supporting a composable architecture that includes partner relationships. HealthEdge will offer APIs for application integration, based on standards, that will allow plans to easily integrate with applications in their IT ecosystem. This will also enable HealthEdge to create an application partner program and offer a digital marketplace of valuable applications. Additionally, HealthEdge plans to offer a data and analytics platform for health plans to perform operational reporting, ad-hoc analytics, and AI/ML modeling to enhance specific business outcomes.

The HealthEdge data science team is developing analytics to identify process improvements within our products, as well as collaborating with select customers to develop ML models for specific use cases. HealthEdge is committed to supporting digital-first experiences for plans through seamless integration of applications and unified views of data.

What does innovation at HealthEdge look like going forward?

Currently, HealthEdge is focused on the following three areas of innovation:

  1. Efficiency in business processes, workflows, and automation through closer integrations among the HealthEdge product portfolio. While each solution is viable and extraordinary on its own, the unique value is how these applications work together in a meaningful way. The integrated solution suite makes possible a vision where claims processing is enhanced with software-driven payment integrity at the point of service, feeding data to an end-to-end care management solution. The result: Lower administrative and healthcare costs, improved patient outcomes, and regulatory compliance.
  2. Increased automation through analytics and machine learning. HealthEdge is investing in core teams and technologies to create new value and outcomes based on payer and related data. Advanced analytics on administrative and clinical data will yield operational insights into improvement areas such as auto[1]adjudication rates, member dis-enrollment, compliance reporting, member risk-scoring, care interventions and more. Embedding machine learning algorithms seamlessly into operational workflows will support efficient improvement of targeted business KPIs.
  3. Creating an application partner ecosystem through API access and data exchange with the HealthEdge application platforms will provide a variety of additional solutions that deliver value health plans. Applications will be available through a marketplace and will be certified to work with the HealthEdge product portfolio. Health plans can select and deploy the partner applications that enable them to achieve their business goals.

Learn more about HealthEdge and innovation here.

Good digital experiences demand good data

As consumers of digital services in our daily lives, our expectations of personalized self-service experience have been set by the likes of Amazon, Netflix and others. We are very comfortable with transacting digitally for shopping, banking, and so many other activities. Interacting with businesses through apps or the web has become the norm.

The businesses who must provide this capability to their customers, typically have to go through a “digital transformation”. They must virtualize delivery of services and the key business processes that enable them. This is done through integrating their information systems and ensuring the right data is available at the right time.

In addition to having data available at the right time, it must be accurate, high quality and complete. High quality data is free from errors, not duplicated, contains all necessary fields and is up to date. Healthcare data is contained in several disparate systems, each used and maintained by separate teams. This leads to a challenge in matching data across systems with a unique identity. Names and addresses need particular attention to ensure that they are spelled and formatted correctly and are unique (consider combinations of initials, middle names and abbreviations).

A data quality program is essential to keep data accurate, by cleansing it of errors and merging from several sources. Errors in data can be prevented by employing a data governance program that prevents errors at data sources. An app user looking for a doctor should be able to see all the correct specialty, office location, hours and network information.

Digital transactions also need access to APIs and real-time data. Information such as eligibility, appointment schedules, payment status must be timely to be useful.

Incorrect or stale data makes for a poor digital experience, and reduces user confidence in the business. Customer experiences are key to retention. A foundation of trusted data as a basis for applications is the key. Good digital experiences demand good data.

The HealthEdge approach to enabling greater access to real-time data centers on three main principles:

– Accurate Data

– Organized Data

– Accessible Data

Learn more about how we are working to give our customers, our applications, and our partners’ unprecedented access to real-time data here.

Innovation at HealthEdge: Past and Future

The journey of transforming healthcare starts with innovation. At HealthEdge, customers can expect transformational business and IT solutions that drive superior business outcomes.

For more than 15 years, HealthEdge has helped customers of all sizes and lines of business transform their organizations, innovate, successfully compete, and achieve breakthrough results.

It all started at the inception of HealthEdge in 2005 with HealthRules Payer®. Our flagship core claims administration solution introduced the unique English-like HealthRules Language®, which transforms the benefit-plan design, network design and contracting process, and makes claims processing faster and easier, while delivering high auto-adjudication rates, high accuracy, and unprecedented transparency. HealthRules is a next-generation platform, recognized by Gartner, KLAS, and other reputable analyst groups.

In 2020, HealthEdge extended its offerings with the acquisition of Source to add claims payment accuracy, pricing, and editing capabilities to our existing offerings. With the acquisition of GuidingCare®, HealthEdge obtained the most successful modern care management platform in the marketplace. This year, we welcome Wellframe and its digital health management capabilities to the family.

Our growth and innovation timeline has led us to serve nearly 100 health plan customers with a combined solution suite that touches over 35 million covered lives across all lines of business. And we’re not stopping anytime soon. Together, HealthRules Payer, Source, GuidingCare, and Wellframe empower customers to effectively compete, improve healthcare quality, and be resilient to changes in the healthcare marketplace. The integrated ecosystem offered by these products moves customers closer to offering a full digital experience to their members.

Looking forward, HealthEdge is focused on three areas of innovation: efficiency in business processes and workflows; increased automation through analytics and machine learning; and creating an application partner ecosystem through API access and data exchange with the HealthEdge application platforms.

We are also committed to a digital-first experience for health plans that complements the composable future-state of the healthcare IT ecosystem. To keep up with digital disruption in the healthcare industry, payers need intelligent, next-generation solutions. Payers who do not invest in next-generation technology will likely be left behind.

As HealthEdge continues to grow, refine our solutions and integrations, and build out partner relationships, health plans can trust that HealthEdge will remain a leading innovation partner with a renewed focus on customer success. I am excited to see where 2022 and the coming years will take us.