HealthEdge Research Highlights Need for Next Generation Technology

“State of the Payor” industry survey shows the overwhelming need to reduce manual processes and increase auto-adjudication rates as payors adopt new healthcare business models

Burlington, Mass. – January 22, 2014 –HealthEdge®, provider of the only integrated financial, administrative and clinical platform for healthcare payors, today announced new data from the latest “State of the Payor” industry survey. While payors begin to participate in or support a number of new healthcare delivery models, antiquated legacy technology systems continue to be a strong barrier to success.

Survey respondents clearly cite the automation of manual processes (81.3 percent) and the need to increase auto-adjudication rates (55.5 percent) as factors that would have a significant impact on reducing administrative costs at their organizations. Manual processing, caused by limitations of legacy technology systems, are preventing payors from achieving this cost reduction. Evidence of this is that 61.4 percent of respondents noted that their organizations are adjudicating less than 80 percent of claims, and 61.3 percent cite paying more than $6 to manually adjudicate a claim.

“It is clear that healthcare payors have a strong desire to transform their organizations and launch initiatives that create new lines of business, increase transparency, reduce administrative costs and improve outcomes,” said Ray Desrochers, executive vice president of Sales and Marketing at HealthEdge. “Our survey results demonstrate that payors attempting this transformation using legacy technology are consistently seeing an increase in manual processing and a decrease in auto-adjudication rates. With next-generation technology like the HealthRules product suite, payors can participate in new business models while simultaneously reducing administrative costs.”

In addition to these findings, HealthEdge also learned that healthcare payors:

  • Have significant interest in Exchanges (64.7 percent), Medicare and Medicaid expansion (63.9 percent) and Accountable Care Organizations (58.6 percent);
  • Are looking to expand transparency, with 47.6 percent of payors seeking to improve transparency with self-service for members, providers, employers and brokers; and
  • Are using the metric of cost of care (76.9 percent of respondents) to gauge the success of their CM/DM/UM initiatives.

More than 130 leaders from health plans across the United States responded to HealthEdge’s “State of the Payor” industry survey. To request the full results or learn more information about the survey, please visit

About HealthEdge

HealthEdge® provides modern, disruptive technology that delivers for the first time, a suite of products that enables healthcare payors to leverage new business models, improve outcomes, drastically reduce administrative costs and connect everyone in the healthcare delivery cycle. Our next-generation enterprise product suite, HealthRules®, is built on modern, patented technology and is delivered to customers via the HealthEdge Cloud or on-site deployment. An award-winning company, HealthEdge empowers payors to capitalize on the innovations, challenges and opportunities that await in the new healthcare economy. For more information, visit