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White Paper: Position Your Health Plan for Long-Term Success with Payment Integrity

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New regulations, evolving technology, and constant cost pressures are forcing organizations to rethink how they manage operations and deliver value. Here’s a snapshot of the key trends and challenges shaping the future:

Emerging Trends

  • Regulatory Complexity: Frequent updates from government agencies like the Centers for Medicare & Medicaid Services (CMS) demand accurate, real-time compliance tracking. Health plans are prioritizing systems that can automate these updates to stay nimble.
  • Digital Transformation: Healthcare is becoming increasingly data-driven. Investments in secure, integrated technologies enable health plans to turn insights into action, while safeguarding sensitive information.
  • Provider Collaboration: Building stronger, transparent partnerships with providers is at the forefront. Efforts focus on reducing claims rework, payment delays, and communication pitfalls.

Current Challenges

  • Over 50% of health plan leaders cite challenges in managing fee schedules and adapting to new rules without sufficient resources or technology vendors.
  • Rising medical costs and staff shortages continue to strain resources. These issues aren’t just financial, they also risk impacting member experiences and provider relationships.
  • Many organizations struggle with siloed data or poorly integrated systems, causing inefficiencies, delays in claims processing, and fractured workflows.

The current challenges in healthcare require bold strategies and forward-looking solutions. For a deeper look into these trends and actionable steps health plans can take, download the full white paper

About the Author

Diana Nguyen is an experienced Product Marketing Manager at HealthEdge, based in Denver, Colorado. With over 3 years at HealthEdge, Diana has held various roles, including Market Research Marketing Manager, Partner & Services Marketing Manager, and Channel Marketing Manager. She currently focuses on driving market awareness and adoption of HealthEdge Source™, the industry-leading payment integrity solution that empowers payers to optimize claims accuracy, minimize errors, and maximize cost savings.

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