HealthEdge Blog

Pricing Transparency & the Impact to Consumers

What is the Transparency in Coverage Rule? Prior to July 1,2022, most consumers of health care services were unaware of how much they cost, including myself.  My primary concern was whether it was...

4 Changes in the 2023 Final Rule that Every D-SNP Health Plan Should Know

In the CY 2023 Final Rule, CMS made several changes that directly impact plans offering Dual Eligible Special Needs Plan (D-SNP) programs, which are a type of Medicare Advantage (MA) plan that are...

Hybrid Work: 6 Secrets to Purposeful Collaboration & Equitable Experiences

Developing your Company Culture: 4 Key Principles  Join us for a 4-part series that explores developing your company culture and taking your organization to the next level. A Culture of Impactful...

5 Simple Steps to Foster Inclusion & Diversity

Developing your Company Culture: 4 Key Principles  Join us for a 4-part series that explores developing your company culture and taking your organization to the next level. A Culture of Impactful...

Continuous Development – The Path to Employee Engagement & Retention

Developing your Company Culture: 4 Key Principles  Join us for a 4-part series that explores developing your company culture and taking your organization to the next level. A Culture of Impactful...

A Culture of Impactful Leadership

Now is the Time for a Fresh Approach to Payment Integrity

Constant Readiness When a Disaster Strikes

Readiness March 2020 represented a critical shift in business operations for local and global companies. For many companies, it was just another day at the office – albeit you were working...

Current State of Payment Integrity

Improving payment integrity has been a challenge for health plans since the beginning of time as the constant battle for accurately pricing claims rages on. To help the market better understand...

How Safety Net Health Plans Can Advance Care Management

Safety Net Plans face unique challenges as they work to connect and engage with hard-to-reach populations to improve the health of the communities they serve. These challenges include: Working...

Tackling the D-SNP Complexities in 2023 with Modern, Interoperable Systems

Enrollment in dual-eligible special needs (D-SNPs) plans grew by 20% in 2022, increasing from 3.8 million in 2021 to 4.6 million beneficiaries in 2022. This population now represents just 20% of...

How to Systematically Integrate Social Determinants of Health into Care Management Programs

Over the past several years, there has been an explosion of interest in social determinants of health (SDOH) data and strategies among healthcare payers, particularly among those who are pursuing...

9 Care Management Platform Must-Haves for Payers

Too many obstacles stand in the way of implementing a person-centered model of care. Complex workflows. A lack of coordination among medical, behavioral and community health organizations....

SummaCare & Source: A Long-Term Partnership for Success

At SummaCare in Akron, Ohio, the customers’ voice can be heard loud and clear. In fact, listening to the needs and wants of the communities it serves is a fundamental principle that has guided...

Introducing Personalized Service Solutions with EDGEcelerate™

Health plans today can face challenges managing their day-to-day operations because of staffing challenges, the regulatory environment, and the need to reduce administrative costs. With the Core...

The Key to Improving the Member Experience Through Improved Payment Integrity

Minimizing member abrasion is a constant challenge for all payers. In fact, according to the 2023 Gartner Group CIO and Technology Executive Survey, improving the member experience is one of the...

The Synergy Between Security and Privacy

Data privacy, although often confused with data security, is a discrete sector in the data protection field drawing upon expertise in law, technology, and ethics. Where data security focuses on...

Three Things Every CIO Should Consider When Evaluating Care Management Solutions

The pace of change in healthcare has accelerated at record speeds in recent years. Many health plan CIOs are struggling to help their businesses adapt quickly due to their dependencies on legacy...

Next Generation Payer Care Management: Why Now, and What Next?

Care management isn’t new. For decades, care managers have been providing information, support, and guidance to members facing chronic and acute healthcare challenges and complex transitions of...