Real-Time Data

HEDIS Final Submission: How Health Plans Can Ensure Accuracy, Compliance, and Confidence

For many health plans, HEDIS® final submission feels like the finish line. In reality, it’s the moment when months of quality improvement efforts, chart retrieval activities, and data validation...

Safeguarding HEDIS Compliance: 5 Strategies for Post-Hybrid Review Documentation and Audit Support  

Key Takeaways Post-hybrid review is a critical audit readiness phase: Success depends on strong documentation workflows, accurate validation, and timely support for auditor requests. Centralized...

Podcast: Current Trends for Payers - Removing Data Siloes 360 Member Journey

Podcast: Current Trends for Payers - From Siloes to Synergy: The Power of a Data Hub

Closing the Gap: Leveraging Hybrid Records to Propel Medicare Advantage Plans to 5 Stars

Achieving a 4.5-Star rating is a major accomplishment for any Medicare Advantage health plan. But moving from 4.5 to 5 Stars is a different challenge altogether. Only a small percentage of plans...

Is Your Health Plan Ready for Touchless Claims Processing?

Is Your Health Plan Ready for Touchless Claims Processing? The pace of change in healthcare continues to accelerate. Don’t let outdated technology keep your organization from seizing new...

RISE National 2026: A Turning Point for Risk Adjustment—and the Work Ahead 

This year marked the 20th anniversary of the RISE National Conference, but the milestone felt less like a retrospective and more like a clear signal of where health plan risk adjustment is heading...

Real-Time Risk Adjustment in 2026: Modernizing Medicare Advantage Programs

Risk adjustment programs are entering a new phase of maturity. Historically, health plans approached Medicare Advantage risk adjustment retroactively, reviewing charts after...

Executive Discussion: Adopting an Ecosystem Operating Model and Measuring ROI 

Part 2 of a 2-part series, where HealthEdge® Vice President of Product Development Bobby Sherwood discusses how a new operating model can transform care operations for health plans. In the first...

Preparing for Software Testing: 8 Best Practices for Health Plans 

When a health plan undertakes a major technology change, whether implementing a new platform, modernizing a legacy system, or rolling out new functionality, the promise is compelling: streamlined...

6 Executive Strategies for Optimizing Care Coordination and Delivery 

At a recent roundtable, the HealthEdge® Chief Medical Officer led executives from three leading health plans in a discussion centered around optimizing care delivery and...

7 Payment Integrity Trends Health Plans Can’t Afford to Ignore in 2026 

Payment integrity has always played a critical role in payer operations, but in 2026, it has become a strategic imperative. According to the HealthEdge® 2026 Annual Payer Survey, health plan...