Discover how our solutions can help your health plan maintain and navigate the complexities of the ever-changing regulatory landscape.
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...
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For the second consecutive year, 52% of health plan executives named “managing rising costs” as the top challenge, according to the 2026 HealthEdge® Annual Payer Report. In the same survey, 85% of...
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Achieving Excellence in a Complex Regulatory Landscape.
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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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Health plans are under increasing pressure: cost, compliance, member experience, and legacy system challenges all converging.
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HealthEdge today announced that it has achieved HITRUST r2 certification for demonstrating the highest level of cybersecurity and information assurance.
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Discover how Nascentia Health partnered with HealthEdge to modernize care management, achieve regulatory compliance agility, and drive measurable operational improvements.
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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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Are you ready to transform compliance into a strategic advantage?
Read the paper!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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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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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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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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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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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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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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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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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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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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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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