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

As health insurance companies push the boundaries of innovation, the ability to scale efficiently becomes a factor for success. Curative Health Plan, known for its groundbreaking zero-deductible, zero-copay model, has disrupted the industry with its commitment to affordability and simplicity. However, rapid growth brings operational challenges—challenges that defining modern, scalable solutions. 

That’s where HealthEdge stepped in. 

Curative’s journey from a startup to a thriving health plan serving nearly 100,000 members in just two short years is nothing short of remarkable. But this level of expansion put immense pressure on their core administrative processing system (CAPS). Their existing platform was not built to handle such a fast-moving, high-growth environment, leading to inefficiencies, manual workarounds, and growing administrative complexity. 

To sustain its rapid expansion without adding significant overhead, Curative turned to HealthEdge and its industry-leading solution, HealthRules® Payer. This strategic move not only enhanced operational efficiency but also reinforced Curative’s ability to provide a seamless member experience. 

A Scalable Platform to Grow with Curative’s Success 

Many health plans anticipate incremental growth, but Curative was different. With membership quadrupling in just one year, their legacy CAPS was simply not equipped to manage the complexity. The lack of automation, brittle integrations, and manual contract calculations were slowing them down at a time when speed and accuracy were critical. 

“Many technology systems work fine with 3-5% membership growth per year, but we quadrupled our membership in a single year. We needed a platform that wouldn't just get us through this phase but could support us up to a million members and beyond,” said the Chief of Staff to the CTO at Curative. 

The HealthRules Payer solution from HealthEdge offered exactly that—a scalable, automated system designed to grow alongside Curative’s ambitions. But beyond the technology itself, it was the expertise of the HealthEdge Global Professional Services team that made the difference. Their hands-on approach ensured a smooth transition, helping Curative optimize workflows, streamline claims processing, and implement automation that would drive long-term success. 

The HealthEdge Advantage: Automation, Integration, and Flexibility 

One of the biggest wins for Curative was HealthRules Payer’s rules-based engine. Unlike traditional systems reliant on rigid, hardcoded logic, HealthRules Payer enabled Curative to define and modify rules dynamically—empowering them with the flexibility they needed to support their unique business model. 

“Moving to a rules-based system gave us a lot more flexibility and control,” the Chief of Staff noted. “Instead of relying on hardcoded logic that required extensive manual intervention, we could define and adjust rules dynamically to meet our evolving needs.” 

Other key benefits included: 

• Higher Auto-Adjudication Rates: Within months, Curative’s auto-adjudication rate nearly doubled, from under 50% to 85%, significantly reducing manual claims processing. 
• Seamless API Integration: With 13 different APIs in use, Curative connected HealthRules Payer to its member portal, allowing brokers and employers to make real-time adjustments. 
• Eliminating Manual Contract Calculations: A previously time-consuming process was completely automated, improving accuracy and reducing errors. 
• Faster Claims Processing: Members experienced fewer delays, strengthening their trust in Curative’s zero-copay, zero-deductible model. 

“The ability to automate key processes through APIs was a big win,” the Chief of Staff added. “It allowed us to reduce administrative complexity while improving accuracy and efficiency.” 

Lessons for Other Health Plans 

For health plans considering a transition to a new CAPS, Curative’s experience provides valuable insights. Change management practices such as leadership alignment, operational involvement, and a structured escalation pathway were critical to their success. Additionally, clear and regular communication—such as daily updates to the leadership team—helped prevent bottlenecks and ensured swift decision-making. 

“This was a complex process, and having engaged leadership made all the difference,” the Chief of Staff emphasized. “We also made sure our operational teams were involved from the beginning, ensuring that workflows were designed with real-world efficiency in mind.” 

A Future Built for Growth 

With HealthRules Payer in place, Curative is well-positioned to scale without the administrative burden that typically accompanies growth. By leveraging automation, real-time data capabilities, and a flexible rules-based system, they’ve built a foundation for sustainable success. 

As Curative continues its mission to remove barriers to care, HealthEdge remains a key partner in enabling operational efficiency, automation, and scalability. 

Want to dive deeper into how Curative transformed its operations with HealthEdge? Read the full case study to discover the details behind their journey and the powerful impact of modernizing their core administrative system.