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Innovation at HealthEdge: Making Waves in Healthcare Payer Technology

The journey of transforming healthcare starts with innovation. We recently sat down with Sanjeev Sawai, Chief Innovation Officer at HealthEdge, to understand how innovation can be traced to the roots of HealthEdge and what innovation looks like going forward.

What is HealthEdge’s role in the digital transformation of the healthcare landscape?

To keep up with digital disruption in the healthcare industry, payers need intelligent, next-generation solutions. Payers who do not invest in next-generation technology will likely be left behind. HealthEdge offers modern, flexible, and inter-operable solutions that pave the way for payer strategies to meet tomorrow’s shifting market demands. HealthEdge accelerates digital transformation in healthcare through facilitating real-time transactions, integrating applications with IT systems, and making real-time data available.

How will HealthEdge provide health plans with data and technology to support the entire healthcare ecosystem?

At HealthEdge, we understand that the payer ecosystem is large and complex. That is why all HealthEdge products are built to seamlessly integrate with all vendors and technology needed for our customers to do business. Our focus is on supporting a composable architecture that includes partner relationships. HealthEdge will offer APIs for application integration, based on standards, that will allow plans to easily integrate with applications in their IT ecosystem. This will also enable HealthEdge to create an application partner program and offer a digital marketplace of valuable applications. Additionally, HealthEdge plans to offer a data and analytics platform for health plans to perform operational reporting, ad-hoc analytics, and AI/ML modeling to enhance specific business outcomes.

The HealthEdge data science team is developing analytics to identify process improvements within our products, as well as collaborating with select customers to develop ML models for specific use cases. HealthEdge is committed to supporting digital-first experiences for plans through seamless integration of applications and unified views of data.

What does innovation at HealthEdge look like going forward?

Currently, HealthEdge is focused on the following three areas of innovation:

  1. Efficiency in business processes, workflows, and automation through closer integrations among the HealthEdge product portfolio. While each solution is viable and extraordinary on its own, the unique value is how these applications work together in a meaningful way. The integrated solution suite makes possible a vision where claims processing is enhanced with software-driven payment integrity at the point of service, feeding data to an end-to-end care management solution. The result: Lower administrative and healthcare costs, improved patient outcomes, and regulatory compliance.
  2. Increased automation through analytics and machine learning. HealthEdge is investing in core teams and technologies to create new value and outcomes based on payer and related data. Advanced analytics on administrative and clinical data will yield operational insights into improvement areas such as auto[1]adjudication rates, member dis-enrollment, compliance reporting, member risk-scoring, care interventions and more. Embedding machine learning algorithms seamlessly into operational workflows will support efficient improvement of targeted business KPIs.
  3. Creating an application partner ecosystem through API access and data exchange with the HealthEdge application platforms will provide a variety of additional solutions that deliver value health plans. Applications will be available through a marketplace and will be certified to work with the HealthEdge product portfolio. Health plans can select and deploy the partner applications that enable them to achieve their business goals.

Learn more about HealthEdge and innovation here.