Opportunities, Collaboration and Innovation in 2021

The biggest issue facing payers today is that their business changes every year. The pressure to develop reimbursement methodologies with providers that account for the quality of care, access to care, and value-based payment models has increased. Regulatory updates, the worldwide pandemic, and ever-present competition impact payers on an ongoing basis. There are also growing requirements for payers to transact with their members, providers, and employer groups in a modern way. Take Amazon and other B2C businesses; as consumers, we have become accustomed to an easy online buying process and have come to expect this with all transactions.

These collective stakeholder demands have resulted in an industry required to act, behave, and structure its activities in a completely new way. At HealthEdge, it’s our goal to get out ahead of that and help our customers meet, and exceed, these expectations.

We believe that health plans deserve to have a highly automated, accurate, real-time computing infrastructure, and we know our core HealthRules® product, while serving as the heartbeat of key payer operations, can’t do it alone. That is why in 2020, we acquired Burgess Source® to add claims payment accuracy, pricing, and editing, complementing and enhancing our existing adjudication capabilities and most recently Altruista GuidingCare®, the most successful modern care management platform in the marketplace. Our customers can come to work with us for the first time through any of the three products, as they are available on a standalone basis today and in the future and can work with any technology infrastructure in the market.

The integration of Burgess Source and GuidingCare with the HealthRules core administrative claims processing system allows our customers to experience significant benefits from the combined capabilities.

We’re bringing together best-in-class solutions that drive the three most important value streams within a health plan. These value streams cut across the administrative costs of running the business, the medical expenses of paying claims, and the effort to help members with acute or chronic conditions comply with their treatments and obtain better care and better lifestyles.

These integrated solutions make possible a vision where claims processing is enhanced with software-driven payment integrity at the point of service that feeds data to an end-to-end care management solution.

With three, next-generation, cloud-based applications, this combined solution suite is the first-of-its-kind. While each product is viable and extraordinary on its own, we believe the unique value is how these applications work together, enabling automation and workflow efficiencies in a meaningful way. Other options in the marketplace can take years to connect to one another. HealthEdge already has health plans across the country successfully using a combination of these products.

Together, HealthEdge, Burgess, and Altruista empower customers to effectively compete and be resilient to changes in the healthcare marketplace. We will continue to build out from our core system and enable our customers to add next-generation technologies that lower administrative and healthcare costs while improving patient outcomes and quality and supporting regulatory compliance.

As we embark on the new year, I am most excited to accelerate our levels of collaboration and innovation so we can continue elevating health insurance and healthcare.