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 business or adapting to new government regulations, it’s critical to regularly assess and optimize technology solutions. Periodic review of your digital ecosystem can help:
- Automate and streamline workflows
- Enhance cost savings
- Adopt modern product capabilities
- Ensure regulatory compliance
Digital optimization can have significant financial and operational benefits for health plans. According to the 2024 CAQH Index, the healthcare industry can reduce its administrative costs by $20B by moving from manual to electronic transactions. For example, it costs a payer $3.41 to manually process a prior authorization. When the authorization is processed electronically, it costs $0.05—a savings of 98% per transaction. Similarly, when a health plan pends a claim and works it manually, it can add 1-2 weeks to the claim’s processing time.
How Can Optimization Services Support Health Plan Strategy?
Many health plans are interested in strategic optimization but aren’t sure where to begin. The best place to start is with an optimization assessment. Delivered by HealthEdge® Global Professional Services (GPS) subject matter experts, an optimization assessment is a strategic engagement to evaluate your current HealthEdge system set up and workflows. Our team also provides a detailed, prioritized report of recommendations and next-step guidance. The goal of the assessment is to identify improvement opportunities, reduce operational costs, enhance the end-user experience, and ensure you realize the full value of your HealthEdge solutions.
Our Global Professional Services team can also support targeted optimization projects. For example, our GPS team partnered with a customer who was facing a common challenge: matching claims with authorizations. Our subject matter experts assessed their system and identified multiple opportunities to improve their claim-authorization matching. As a result, this customer achieved a 56% reduction in their pend rate for authorization-related claims—that’s a 56% reduction in claims requiring manual work!
Another key area for optimization and cost savings is automation. The 2024 CAQH report highlighted prior authorizations as a prime candidate for automation, noting that on average, providers and staff spend 24 minutes per prior authorization request when using phone, fax, or email. This past year, HealthEdge Global Professional Services released the Prior Authorization Catalog, an advanced rule processing engine that automates prior authorization decisions. This scalable solution is designed to handle high volumes of data, enabling payers to support complex decision automation while simplifying workflows for health plan administrators.
EDGEcelerate Optimization Services from HealthEdge
Our Global Professional Services Team is committed to helping our customers harness the power of optimization to ensure their technology evolves alongside their business. To achieve this, we offer EDGEcelerate, a flexible subscription-based GPS offering designed to help health plans unlock the full potential of their HealthEdge solutions. With EDGEcelerate, you gain a dedicated allocation of Global Professional Services support hours each year—allowing you to optimize, adapt, and innovate faster without the administrative burden of managing multiple contracts.
Why EDGEcelerate?
- Optimization-Focused: Shift from reactive, one-off projects to a proactive, planful strategy that maximizes your technology investment.
- Flexibility: Choose the level of support your organization needs and use your allocated hours across a wide range of initiatives—no need for separate contracts for every project.
- Predictability: Simplified, subscription-based contracting gives you faster access to expert resources and greater control over your budget.
- Dedicated Expertise: Partner with a consistent team of HealthEdge product and industry experts who know your systems, your business model, and your goals.
To learn more, read the full EDGEcelerate data sheet or contact your Customer Success Executive.
