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How BPaaS and Technology Modernization Answer the Call for Health Plans in 2026

Published Date
Author HealthEdge

As health plans face mounting cost pressures and an increasingly complex regulatory landscape, one thing has become clear: incremental change is no longer enough. Today’s health plan environment demands transformational solutions, and a growing body of evidence points to the combined power of technology and Business Process as a Service (BPaaS) as the most effective path forward.

The HealthEdge® 2026 Healthcare Payer Survey Report reveals just how urgent the moment has become. Cost containment remains the number one challenge for the second year in a row, while regulatory compliance has surged near the top of the list, driven in part by sweeping changes introduced through the One Big Beautiful Bill Act (OBBBA).

The Market Shift: Cost and Compliance Are Forcing a Strategic Reset

With healthcare costs projected to reach $7.7 trillion by 2032, outpacing both inflation and wage growth, health plans are under extreme pressure to modernize operations while improving compliance and outcomes. According to the HealthEdge survey:

  • 85% of health plan executives say regulatory pressures are significantly impacting margins
  • 34% are turning to technology like AI and analytics to reduce costs
  • An increasing number of health plan leaders are exploring outsourcing and shared services models, recognizing their promise in balancing cost, compliance, and modernization.

The Power of “AND”: Technology and BPaaS Together

Too often, health plans view BPaaS and technology modernization as separate strategies. But in today’s environment, success lies not in choosing between the two—but in using them together.

With the recent merger of HealthEdge and UST HealthProof, health plans now have access to a unified platform that combines best-in-class, AI-powered core technology with proven BPaaS capabilities. This new offering delivers what today’s health plans truly need: a scalable, intelligent, and compliant operational model that can reduce costs, boost agility, and enhance outcomes, all under one roof.

As stated in the official merger announcement, this new entity creates “a disruptive AI-powered healthcare health plan technology and services leader” designed to meet the end-to-end needs of modern health plans. Now, health plans no longer have to compromise between innovative software and high-performing services. They can have both: the platform and the people to drive results.

How the Combined BPaaS Model Works

According to a recent Everest Group report, Next-Generation BPaaS: A New Era of Efficiency for Health Plans, next-generation BPaaS can reduce total cost of ownership (TCO) by up to 50%, drive 95% enrollment automation, and increase claims auto-adjudication to 95% or more, especially when integrated with AI-powered technology platforms.

Here’s how combining BPaaS + technology delivers value across health plan priorities:

  • Cost Efficiency: BPaaS embeds automation and analytics into core workflows, reducing manual labor and administrative spend. Pairing this with modern claims and care management platforms further cuts inefficiencies and TCO.
  • Regulatory Agility: New mandates like OBBBA and interoperability rules from the Centers for Medicare and Medicaid Services (CMS) require real-time data exchange and governance. With a unified solution, health plans gain built-in compliance frameworks and the agility to adapt to changing requirements.
  • Member and Provider Experience: Health plans can scale digital engagement, offer omnichannel support, and integrate provider data—improving satisfaction and reducing friction across the ecosystem.
  • Speed and Scalability: With pre-configured, low-code tools and embedded AI, health plans can accelerate implementation, reduce time-to-value, and respond quickly to business changes.

Turning Insights into Action

The 2026 Health Plan Survey makes it clear: health plans are ready for change, but too many are still making isolated, tactical investments. To thrive in today’s climate, they need a cohesive operating model that merges advanced technology with operational execution.

HealthEdge provides this model, now offering an integrated solution that transforms the way health plans operate, enabling them to reduce costs, meet regulatory demands, and deliver the experience stakeholders and members have come to expect.

Download the full 2026 Healthcare Payer Survey Report, The Great Rebalancing: Inside the New Realities Shaping Health Plan Performance, to explore all the insights driving the more than 550 health plan leaders today.