How an Integrated Ecosystem and Technology Modernization Answer the Call for Health Plans
Health plans face increasing pressure to manage costs, ensure regulatory compliance, and improve the member experience, all while dealing with the limitations of legacy systems. Executives are seeking solutions that deliver speed, predictable costs, and measurable outcomes.
The HealthEdge Solution: A Fully Integrated Ecosystem
HealthEdge provides an end-to-end platform that modernizes operations and maximizes the return on investment (ROI) from your core administrative system. Our innovative ecosystem leverages the power of HealthRules Payer by combining software, services, and process innovation into a single, outcome-driven platform with flexible operating models. This approach cuts complexity and is proven to reduce costs by 30-40% Per Member Per Month (PMPM).
Comparing Operating Models: HealthEdge vs. Traditional Vendors
The HealthEdge advantage becomes clear when comparing our integrated ecosystem to a fragmented, multi-vendor model.
|
Feature |
Core HealthRules Payer |
HealthEdge Integrated Ecosystem |
|
Accountability |
Platform owned internally, but outcomes are spread across vendors. |
One partner is accountable for end-to-end performance and outcomes. |
|
Operating Model |
A modern core system within a fragmented vendor model. |
End-to-end operations are integrated and run on HealthRules Payer. |
|
Administrative Cost |
High and variable due to disparate staffing, rework, and vendor management. |
Low, predictable costs achieved through highly scaled operations. |
|
Operational Visibility |
Reactive, with KPIs tracked in silos and issues surfacing late in the process. |
Proactive, with a single dashboard providing early risk indicators. |
|
Leadership Focus |
Concentrated on managing daily operations and multiple vendors. |
Freed to focus on strategy, growth, and improving member outcomes. |
|
ROI from HealthRules Payer |
Foundational: opportunities to increase ROI with fewer operating silos. |
Maximized: one partner manages it all, backed by SLA's and guaranteed outcomes. |
Delivering Measurable Outcomes and Tangible ROI
By adding the HealthEdge integrated ecosystem to your HealthRules Payer core administration, you can achieve significant, quantifiable improvements across financial, strategic, and technical domains.
Guaranteed Performance Metrics
- Speed: Achieve a 9–18 month implementation, which is 40% faster than the 24–36 months typical with other vendors. This allows for faster time-to-market, unified operations, and greater product agility.
- Savings: Realize guaranteed PMPM savings of 30–40%, a significant increase compared to the 10–15% seen with other solutions.
- Predictability: Maintain a budget variance of less than 1% and enjoy a transparent total cost of ownership with a single PMPM fee and no unexpected upgrade projects.
- ROI: Reach a positive return on investment in just 12–15 months, compared to the 24–36 month industry average.
By converging data onto a single platform, we empower health plans to harness automation and the promise of AI. This combination of next-generation technology, expert services, and deep industry knowledge gives health plans unmatched capabilities to deliver a future of frictionless and cost-effective healthcare experiences.
Let HealthEdge ease your operational burden so you can focus on innovation, member outcomes, and growing your business. Contact us to learn how we can take your health plan to the next level.
