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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See how over 450 health plan leaders are preparing for 2025!
Learn MoreThe 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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Imagine this scenario: A critical exception fires in your company’s observability tool. Someone needs to check the logs, categorize the severity, and create a defect in the systems’ project...
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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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Across the healthcare industry, organizations are making do with a payment integrity process that relies on a complex web of disparate systems, multiple vendors, and manual ticketing processes....
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See what 3,500 consumers say about their healthcare experiences
Read the report!How integrated HealthEdge® technology helps improve member outcomes, reduces spend, and delivers on the promise of coordinated care. Ask any care manager why they chose their profession, and the...
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At HealthEdge®, we understand that efficient provider data management is fundamental to delivering quality healthcare. Yet, the reality for many health plans is that maintaining accurate provider...
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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 healthcare payer landscape is undergoing a seismic transformation, as revealed by the 2026 HealthEdge® Annual Payer Report. HealthEdge surveyed more than 550 health plan executives, including...
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As the healthcare industry prepares for the ripple effects of the One Big Beautiful Bill Act (OBBBA), few payer segments face more immediate challenges than health plans focused on Medicaid...
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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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As health plans become increasingly reliant on complex software platforms to manage operations, timely access to accurate product information is essential. Yet traditional documentation search...
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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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AI is reshaping how software gets built—enabling faster delivery, real-time iteration, and deeper collaboration between technical and business teams. At HealthEdge®, we’re exploring how AI-driven...
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In an industry flooded with point solutions, health plans are realizing that using more tools don’t necessarily lead to more value. From member engagement apps and wellness portals to survey...
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Health plan leaders have dozens of digital solutions to choose from—so many that it can feel like real partnership is rare. Too often, vendors deliver software and walk away, leaving health...
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Better outcomes, lower costs: Why health plans are turning to HealthEdge® Wellframe Across the healthcare industry, many health plans grapple with vendor sprawl—a web of disparate systems and...
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By Rob Duffy, CTO, HealthEdge It’s easy to talk about innovation in healthcare technology; it’s harder to build it in a way that scales for health plans and improves real outcomes. At HealthEdge,...
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