HealthEdge Blog

Enhance Automation and Cost Savings with EDGEcelerate Optimization Services

Your health plan is constantly growing and expanding—and your digital ecosystem should be able to keep pace and scale with your organization. Whether your health plan is adding new lines of...

How an Integrated Digital Ecosystem Enables Success for Health Plans

Health plan executives face increasing demand to deliver frictionless experiences, from streamlined operations to a modern member experience, to stay competitive in a rapidly evolving market. At...

Improve Care Coordination and Delivery with AI & HealthEdge GuidingCare®

Healthcare is undergoing a transformation, and artificial intelligence (AI) is a major part of this evolution. From improving diagnostic accuracy to transforming care coordination workflows, AI...

Key Considerations for Evaluating Digital Member Engagement Solutions

The digital transformation of healthcare has fundamentally shifted member expectations. Today’s members expect more than convenience. They want clarity on their care, real-time access to guidance,...

Healthcare’s Inflection Point: Why Convergence Is the Only Path Forward

The healthcare industry is entering a critical phase of reinvention. Legacy technologies and decades-old operational models are no longer sufficient in today’s complex, data-rich, and high-demand...

Six Steps for Accelerating Digital Member Engagement’s Time to Value  

Health plans face evolving industry dynamics that demand quick action and measurable outcomes. Rising member expectations, regulatory requirements and financial considerations all point toward the...

HealthEdge's Strategic Vision for the Future

The healthcare payer market is at a critical juncture, driven by increasing market pressures, consumer demands, and the need for technological modernization. At HealthEdge®, we believe payers have...

Transforming Healthcare Technology: Building Intelligent Ecosystems from Siloed Systems

Healthcare is at a crossroads. Legacy platforms, endless point solutions, and mounting regulatory pressure are all warning signs on the road to change. The need for transformation is clear, even...

How Improving Auto-Adjudication Rates Can Enhance Health Plan Performance

For modern health plans, enhancing auto-adjudication rates is more than a technical upgrade. It is a strategy for payers aiming to stay competitive by increasing automation, improving efficiency,...

Building a More Intelligent Payment Integrity Process: AI Enhancements in HealthEdge Source

In a recent webinar, two HealthEdge Source™ product leaders demonstrated how our teams are integrating artificial intelligence (AI) into our solutions to enhance experiences and outcomes for...

Comprehensive AI Glossary: Key Terms for Payers Explained

Dive into our AI glossary tailored for health plans and payers. Learn essential terms like Machine Learning, Generative AI, and NLP to understand their impact on healthcare operations and payer...

HealthEdge® CTO Update: Key Areas of Investment for 2025

In our December IMPACT customer event, we introduced a few key areas of investment at the platform level, and I have some exciting updates to share with you on customer experience, integrations...

How the HealthEdge® AI Summarizer Empowers Teams to Deliver Personalized Care at Scale

Care managers are responsible for far more than delivering care. They coordinate member communication, update health records, navigate program changes, and play a crucial role in ensuring...

Scaling Smartly: How Curative Health Plan Leveraged HealthEdge® to Power Growth and Achieve Operational Efficiencies

Advancing Health Equity: Strategies for Health Plans Navigating Change, Compliance, and Innovation

As regulatory guidelines evolve and the emphasis on improving healthcare access and outcomes intensifies, health plans that serve Medicaid and D-SNP populations face an urgent mandate to improve...

Navigating CMS 2027 D-SNP Requirements: Preparing Your Health Plan for HIDE and FIDE SNP Compliance

Health plans serving dual-eligible populations face significant regulatory changes from the Centers for Medicare & Medicaid Services (CMS). The 2027 D-SNP requirements introduce significant...

Creating a Culture of Innovation to Accelerate AI Adoption

Artificial Intelligence (AI) is transforming healthcare by helping payers streamline operations, reduce costs, and enhance experiences for staff, members, and providers. However, health plans must...

Pursuing NCQA Accreditation: How Wellframe™ Is Enabling Health Plans to Address SDOH

Now more than ever before, health plans are recognizing the importance of holistic care delivery to improve outcomes and reduce costs. Social determinants of health (SDOH) such as food security,...

The Health Plan’s Guide to Payment Integrity Solutions

Payment integrity solutions are becoming an increasingly essential part of payers’ digital ecosystems. An integrated payment integrity platform can work with a health plan’s existing technology...