Brochure: Optimize Health Plan Performance with Stars Consulting Solutions
Achieving Excellence in a Complex Regulatory Landscape.
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Compliance
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Is Your Legacy Care Management System Holding You Back? 5 Signs to Make the Switch
In today’s rapidly evolving healthcare landscape, standing still isn’t an option. Health plans relying on legacy care management platforms, whether vendor-supported, homegrown, or heavily...
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HealthEdge Achieves HITRUST Risk-based, 2-year Certification to Manage Risk, Improve Security Posture, and Meet Compliance Requirements
HealthEdge today announced that it has achieved HITRUST r2 certification for demonstrating the highest level of cybersecurity and information assurance.
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eBook: Care Management Implementation Best Practices for Regulatory Compliance Agility
Discover how Nascentia Health partnered with HealthEdge to modernize care management, achieve regulatory compliance agility, and drive measurable operational improvements.
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Elevate Care Management with the Integrated Power of HealthEdge GuidingCare®
Industry pressures like regulatory complexity and the shift toward value-based care demand that health plans take an integrated, strategic approach to care management. Whether payers are...
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New Research: How Rising Costs and Regulatory Pressures Are Reshaping Health Plan Priorities
Rising costs. Relentless regulation. For health plans, the question isn’t whether these pressures are intensifying. It’s how to respond. According to new research from HealthEdge®, these twin...
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From Petabytes to Practicality: Navigating the New CMS Transparency Rule
The Transparency in Coverage (TiC) final rules of 2020 promised a revolution in healthcare price transparency. The vision was bold: empower consumers with data to drive competition and lower...
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How BPaaS and Technology Modernization Answer the Call for Health Plans in 2026
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...
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What Wellframe’s New NCQA Certifications Mean for Health Plans and their Members
As regulatory and quality expectations intensify, the National Committee for Quality Assurance (NCQA) vendor certification offers health plans a trusted signal that their technology partners can...
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Professional Services Spotlight: Helping Texas Health Plans Stay Compliant and Efficient with MNLOC Assessment Enhancements
When state regulations change, health plans must be ready to respond—particularly when those changes impact core Medicaid services. That was the case in 2025 when the State of Texas mandated...
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Building Regulatory Compliance Agility: Lessons from Nascentia Health’s Success Story
Implementing new care management technology is about more than just meeting a go-live date. For Medicaid and Long-Term Services and Supports (LTSS) plans navigating evolving state mandates,...
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Payer Priorities 2026: Balancing Cost, Compliance, and Connection in a Time of Disruption
The HealthEdge® 2026 Annual Payer Report, “The Great Rebalancing: Inside the New Realities Shaping Health Plan Performance,” reveals how health plans are navigating growing financial pressure,...
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From Guessing Game to Proactive Process: Simplify Edits with HealthEdge Source™
Managing payments for a health plan is not as simple as it was a few decades ago. Updated billing models, new compliance mandates, and complex provider networks can make it challenging for payers...
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Intensifying Regulatory Pressures Force Seismic Shift in Health Plan Concerns for 2026 According to HealthEdge Research
HealthEdge’s 2025 survey of 550 health plan executives reveals a major shift in payer priorities, with regulatory pressures and cost management topping the list. The report highlights strategies like
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Navigating Dual-Eligibility: Regulatory Compliance and Strategic Opportunities for Health Plans
Dual-eligible individuals—those who qualify for both Medicare and Medicaid—represent one of the most complex and high-need populations in the U.S. healthcare system.
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The Great Rebalancing: Inside the New Realities Shaping Health Plan Performance
Heightened pressures from rising costs, regulatory complexities, AI disruption, and member and provider network expectations indicate a perfect storm is brewing for health plans.
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Regulatory & Compliance Q&A: How the OBBBA Could Impact Care Management & Member Engagement
On June 10, 2025, the One Big Beautiful Bill Act (OBBBA), also known as H.R.1, was signed into law, marking the beginning of one of the most sweeping healthcare reforms in recent memory. Given the...
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A Strategic Framework to Navigate the One Big Beautiful Bill Act
Sweeping policy changes are nothing new in U.S. healthcare, but the One Big Beautiful Bill Act (OBBBA), also known as H.R. 1, represents a particularly consequential inflection point for health...
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Data Sheet: Future-Proof Your Health Plan with HealthEdge GuidingCare® — FHIR-Driven Solutions Enable Compliance
HealthEdge’s GuidingCare® platform is at the forefront of enabling healthcare interoperability. By combining deep technical expertise with a visionary approach, GuidingCare equips health...
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Modernizing Tech-Enabled Services to Become Tech-Enabled Solutions
Health plans are under increasing pressure to modernize operations while managing rising costs, regulatory complexity, and evolving member expectations. Many have adopted tech-enabled services to...
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