The complex landscape of state and federal healthcare regulations continues to evolve, requiring payers to invest in technologies that support their compliance efforts. Next-generation Core...
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See how over 450 health plan leaders are preparing for 2025!
Learn MoreThe Centers for Medicare & Medicaid Services (CMS) has raised performance benchmarks for Medicare Advantage (MA) and Part D plans, raising the bar for achieving high Star Ratings. By excluding the...
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Managing pediatric health within today’s healthcare landscape requires precision, innovation, and unwavering dedication to excellence. Health plans face the dual imperative of delivering tailored,...
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Navigating healthcare regulations and compliance is an intricate challenge. To optimize the use of healthcare dollars and more effectively address population health, The Office of the National...
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Section Guide: Key investments for member engagement Overcoming barriers to member satisfaction 7 Key strategies for boosting member engagement Impacts of transforming member engagement Key...
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Effective provider engagement is fundamental to reducing administrative costs and improving member outcomes. However, as operational complexities persist and healthcare demands increase, the need...
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See what 3,500 consumers say about their healthcare experiences
Read the report!The U.S. maternal health system faces a troubling crisis: Disparities in maternal health outcomes disproportionately affect Black, American Indian/Alaska Native (AIAN), and Native Hawaiian/Pacific...
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Health plans today are under increasing pressure to modernize their technology and processes to adapt to the complexities of modern healthcare and take advantage of market growth opportunities....
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The healthcare industry has long been a primary target for cyberattacks due to the vast amount of sensitive data it handles. The increasing prevalence of cyber incidents, combined with...
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Many health plans continue to rely on legacy Core Administrative Processing Systems (CAPS) as the backbone for managing critical operations such as claims processing, benefit configuration, and...
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Health plans face continual pressures to modernize their services and provide personalized offerings to broader member populations—without breaking the budget. For 36% of health plan leaders,...
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For healthcare payers, complying with shifting regulations can be a challenge. Increasingly, state and federal guidelines focus on improving cost transparency while improving patient data safety....
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In a recent webinar hosted by the Association for Community Affiliated Plans, Anna Dunn, the president of Health Services for Children with Special Needs (HSCSN), shared her experience...
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According to the Annual Payer Market Planning Report from HealthEdge®, technology modernization is one of the top concerns for health plan leaders. Modern healthcare technologies are characterized...
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As we approach 2025, health plan executives are facing new challenges and opportunities. The HealthEdge® Annual Payer Market Planning Report 2025 outlines the top priorities, investments, and...
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In the complex landscape of U.S. healthcare, payers face pressures from all directions. Stakeholders are looking for ways to streamline workflows so they can minimize errors and accelerate time to...
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Artificial Intelligence (AI) is transforming payment integrity in the health insurance industry, particularly in detecting and preventing fraudulent payments and waste. As fraudulent claims become...
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Maternal morbidity rates in the U.S. are in the spotlight—particularly the disparities many Black women face compared to their white counterparts. Despite advances in medical technology and...
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In the rapidly evolving landscape of healthcare technology, staying ahead of competitors requires organizational commitment to modernization. Investing in a modern healthcare core administrative...
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Health plan administrators must adhere to the complex guidelines related to payment integrity, operational efficiency, and regulatory compliance. The claims process is intricate, and the sheer...
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